摘要
目的探讨初始离子钙、休克指数比值(rSIG)和ISS评分(创伤严重程度评分)对ICU创伤患者预后的评估价值。方法回顾性分析2020年1月至2021年12月联勤保障部队第九二〇医院ICU收治的184例创伤患者的临床资料。以28 d预后为终点,将患者分为存活组和死亡组,比较2组患者一般临床资料、iCa^(2+)、rSIG和ISS评分的差异。采用多因素Logistic回归分析筛选出影响创伤患者死亡的危险因素;绘制受试者工作特征(ROC)曲线,分析初始iCa^(2+)、rSIG和ISS评分对创伤患者的预测效能。结果共纳入184例ICU创伤患者,28d存活166例,死亡组18例。存活组患者初始iCa^(2+)水平高于死亡组[1.073±0.11mmol/L vs 1.0±0.15 mmol/L,P<0.05]、rSIG值显著大于死亡组[15.82(12.65,19.9)vs 5.89(2.3,11.41),P<0.001]、ISS评分显著低于死亡组[23.04±8.89 vs 35.89±9.09,P<0.001]。Logistic回归分析结果显示,年龄(1.061,95%CI:1.004~1.122,P=0.035)、急诊机械通气(5.237,95%CI:1.113~24.648,P=0.036)、iCa^(2+)(0,95%CI:0.000~0.081,P=0.011)是影响ICU创伤患者28 d死亡的独立危险因素。ROC曲线分析显示,rSIG、iCa^(2+)及ISS评分均对创伤患者预后预测ROC曲线下面积(AUC)分别为0.833、0.623、0.835(均P<0.05);单独预测能力ISS评分最优,iCa^(2+)的特异度最高(97%),rSIG的敏感度最高(83.3%),iCa^(2+)联合ISS预测的AUC高达0.9,敏感度为83.3%,特异度为86.1%,提示两者联合变量对创伤患者死亡的准确性更高。结论ICU创伤死亡者具有低iCa^(2+)值、rSIG低值及ISS高评分。初始iCa^(2+)与ISS评分联合对创伤患者预后的预测能力最佳。
Objective The study aims to evaluate the prognostic value of initial ionized calcium,the reverse shock index multiplied by Glasgow Coma Scale(rSIG),and injury severity score(ISS)in trauma patients in ICU.Methods A retrospective analysis was conducted among 184 trauma patients admitted to the ICU of the 920th Hospital of Joint Logistics Support Force from January 2020 to December 2021.With the 28d-prognosis as the end point,the patients were divided into the survival group and the death group.The general clinical data,iCa^(2+),rSIG and ISS score were compared between the two groups.Multivariate logistic regression analysis was adopted to sift out the risk factors for the death of trauma patients.Receiver operator characteristic curve(ROC curve)was drawn to analyze the predictive efficacy of the iCa^(2+),rSIG and ISS score.Results Among the 184 trauma patients,166 patients survived and 18 of them died within 28 days.Compared to the death group,the initial ionized calcium level of the survival group[1.073±0.11mmol/L vs 1.0±0.15 mmol/L,P<0.05]were higher,the rSIG of the survival group was significantly higher[15.82(12.65,19.9)vs 5.89(2.3,11.41),P<0.001],the ISS score of the survival group was significantly smaller[23.04±8.89 vs 35.89±9.09,P<0.001].Logistic regression analysis suggested that age(1.061,95%CI:1.004~1.122,P=0.035),emergency mechanical ventilation(5.237,95%CI:1.113~24.648,P=0.036),and iCa2+(0,95%CI:0.000~0.081,P=0.011)were independent risk factors for the death of the ICU trauma patients within 28 days.According to the ROC analysis,the Area Under Curve(AUC)of rSIG,iCa2+and ISS score were respectively 0.833(P<0.05),0.623(P<0.05),0.835(P<0.05).ISS score showed the best predictive efficacy as a sole factor,while the specificity of iCa^(2+)was highest(97%),and the rSIG demonstrated the highest sensitivity(83.3%).The AUC of the combination of iCa^(2+)and ISS score was as high as 0.9,with a sensitivity of 83%and a specificity of 86.1%,suggesting that such combined variable have higher accuracy in the prediction of death.Conclusion Dead ICU trauma patients had low iCa^(2+)value,low rSIG value and high ISS score.The combination of initial iCa^(2+)and ISS score showed the best predicative efficacy for the prognosis of trauma patients.
作者
王铭
吕晓雨
罗雨青
王新军
谢忠珊
潘险峰
WANG Ming;L Xiaoyu;LUO Yuqing;WANG Xinjun;XIE Zhongshan;PAN Xianfeng(Kunming Medical University,Kunming 650500,Yunnan,China;Department of Emergency,920th Hospital of Joint Logistics Support Force,Kunming 650100,Yunnan,China)
出处
《医学研究与战创伤救治》
CAS
北大核心
2023年第2期148-152,共5页
Journal of Medical Research & Combat Trauma Care
基金
云南省卫健委临床中心建设重大项目(ZX20191001)。
作者简介
通信作者:潘险峰,E-mail:Xianfengpan@outlook.com。
