智能计算法评估危重创伤患者早期肝损伤风险的回顾性研究  

Early liver injury risk assessment in critically injured trauma patients using intelligent calculation method:a retrospective study

作　　者：侯晓明 赵文君 李文华 王小梅 曾保起 刘晓智[3] 冯庆国[1] 康波 薛娜 Hou Xiaoming;Zhao Wenjun;Li Wenhua;Wang Xiaomei;Zeng Baoqi;Liu Xiaozhi;Feng Qingguo;Kang Bo;Xue Na(Department of Critical Care Medicine,Tianjin Fifth Center Hospital,Tianjin 300457,China;Department of Emergency Medicine,Tianjin Fifth Center Hospital,Tianjin 300457,China;Department of Centarl Laboratory,Tianjin Fifth Center Hospital,Tianjin 300457,China;National SuperComputer Center in Tianjin,Tianjin 300457,China)

机构地区：[1]天津市第五中心医院重症医学科,天津300457 [2]天津市第五中心医院急诊医学科,天津300457 [3]天津市第五中心医院中心实验室,天津300457 [4]国家超级计算天津中心,天津300457

出　　处：《中华危重病急救医学》2025年第2期165-169,共5页Chinese Critical Care Medicine

基　　金：天津市卫生健康科技项目(ZC20034)。

摘　　要：目的探讨智能计算法评估的危重创伤患者早期各项肝功能指标的变化特点,以期构建更具优势的创伤性肝损伤诊疗策略。方法采用回顾性研究方法,选择2022年1月1日至2023年12月1日天津市第五中心医院急诊医学中心的危重创伤住院患者〔创伤严重程度评分(ISS)≥16分,年龄>18岁〕。收集患者入住急诊医学中心时由智能计算法计算的ISS评分和急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)。分析患者入院6、24、72 h空腹静脉血清中的肝功能指标〔丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、碱性磷酸酶(ALP)、γ-谷氨酰转移酶(GGT)、乳酸脱氢酶(LDH)、白蛋白(ALB)、总胆红素(TBil)、凝血酶原时间(PT)〕的变化趋势。采用分组对照研究方法,将患者分为APACHEⅡ>15分组和APACHEⅡ≤15分组,比较两组患者入院6 h内的肝功能指标。结果最终纳入112例危重创伤患者,其中男性83例,女性29例;平均年龄(47.78±14.84)岁;中位ISS评分21.0(18.0,26.0)分。危重创伤患者最常见的致伤因素是车祸外伤(68例,占60.71%),其次为高处坠落伤、挤压伤、重物砸伤、刀刺伤、爆炸伤;最常见的受伤部位是四肢及骨盆(97例,占86.61%),其次为胸部损伤、体表皮肤软组织损伤、腹部及盆腔器官损伤、头部损伤、面部损伤。患者入院6 h内LDH、AST和ALT升高比例分别为77.68%、79.46%、52.68%,ALB下降比例为75.89%,ALP、GGT、TBil、PT异常率均低于50%。患者入院24 h和72 h的ALT、AST水平均较入院6 h时明显下降〔ALT(U/L):37.0(22.0,66.0)、31.0(21.2,52.0)比41.0(25.0,71.0),AST(U/L):55.5(30.0,93.5)、40.0(27.0,63.2)比69.5(39.0,130.8),均P<0.05〕。APACHEⅡ>15分组(45例)与APACHEⅡ≤15分组(67例)患者ISS评分比较差异无统计学意义〔分:21.0(18.5,26.5)比20.0(17.0,22.0),P>0.05〕,但与APACHEⅡ≤15分患者相比,APACHEⅡ>15分患者入院6 h内ALT和AST的异常率更高〔ALT异常率:66.44%(29/45)比44.78%(30/67),AST异�Objective To explore the early changes in various liver function indicators in critically injured trauma patients assessed by intelligent calculation method,aiming to develop more advantageous diagnostic and treatment strategies for traumatic liver injury.Methods A retrospective study was conducted.Critically injured trauma patients[injury severity score(ISS)≥16,age>18 years old]admitted to the Emergency Medical Center of Tianjin Fifth Central Hospital from January 1,2022,to December 1,2023 were enrolled.ISS score and acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)assessed by intelligent calculation method were collected upon patient admission to the emergency medical center.Trends in liver function indicators in fasting venous serum were analyzed at 6,24 and 72 hours after admission,including alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP),γ-glutamyl transferase(GGT),lactate dehydrogenase(LDH),albumin(ALB),total bilirubin(TBil),prothrombin time(PT).Patients were grouped based on APACHEⅡ scores into those with APACHEⅡ>15 and APACHEⅡ≤15,and liver function indicators within 6 hours of admission were compared between the two groups.Results A total of 112 critically injured trauma patients were included,with 83 males and 29 females,an average age of(47.78±14.84)years old.The median ISS score was 21.0(18.0,26.0).The most common cause of injury for critically injured trauma patients was road traffic accidents(68 cases,accounting for 60.71%),followed by falls from heights,compression injuries,heavy object injuries,knife stabs,and explosion injuries.The most common injured areas was the limbs and pelvis(97 cases,accounting for 86.61%),followed by chest injuries,surface skin and soft tissue injuries,abdominal and pelvic organ injuries,head injuries,and facial injuries.The proportion of elevated LDH,AST,and ALT within 6 hours of admission was 77.68%,79.46%,and 52.68%,respectively,while the proportion of decreased ALB was 75.89%,the abnormal rates of ALP,GGT,

关 键 词：创伤 肝损伤 创伤严重程度评分 急性生理学与慢性健康状况评分Ⅱ 智能计算法 

分 类 号：R657.3[医药卫生—外科学] R641[医药卫生—临床医学]