摘要
目的观察重庆市某二甲医院重症医学科（ICU）创伤患者多器官功能障碍综合征（MODS）的发生情况，探讨其危险因素并建立简易预警评分系统。方法分析2012年1月1日至2015年12月31日重庆市某二甲医院ICU收治的175例创伤患者的临床资料，根据临床结局将患者分为MODS组（88例）和非MODS组（87例）。比较两组患者的一般情况、各项检查和化验结果，以及损伤严重程度评分（ISS）、新损伤严重程度评分（NISS）、序贯器官衰竭评分（SOFA）、格拉斯哥昏迷评分（GCS）和急性生理学与慢性健康状况评分系统Ⅱ（APACHEII）评分。将单因素分析有统计学意义的指标纳入多因素Logistic回归分析，筛选出影响创伤患者发生MODS的独立危险因素；绘制受试者工作特征曲线（ROC），计算ROC曲线下面积（AUC），评估严重创伤患者预警评分系统预测MODS的价值。结果共入选175例患者，MODS的发生率为50．29％（88／175），急性呼吸窘迫综合征（ARDS）的发病率为53．71％（94／175），病死率为17．71％（31／175）。与非MODS组比较，MODS组患者发生心房颤动（房颤）、中心静脉置管和气管插管的概率较高，感染、ARDS、创伤后凝血病的发病率以及住院时间、SOFA评分和吸入氧浓度（FiO2）均较高，动脉血氧分压（PaO2）、氧合指数（PaO2／FiO2）及GCS评分较低，差异均有统计学意义（均P〈0．05）；此外，两组患者ISS、NISS和APACHEII评分比较差异无统计学意义（均P〉0．05）。多因素Logistic逐步回归分析显示，PaO2／Fi02〈300mmHg（1mmHg=0．133kPa）、房颤、中心静脉置管、3分≤GCS≤8分、9分≤GCS≤12分进入回归模型，将上述5个指标分别进行赋值（4、3、1、2、1分），总分作为MODS的简易评分。ROC曲线分析显示：MODS简易评分预测危重创伤患者发生MODS敏感度为53．41％、特异度为93．10％，AUC为0．794，9
Objective To observe the occurrence of multiple organ dysfunction syndrome （MODS）in patients with trauma in Department of Intensive Care Unit （ICU）, explore its risk factors and establish a simple early warning scoring system. Methods The clinical data of 175 traumatic patients admitted to Department of ICU in a grade II A general hospital in Chongqing from January 1, 2012 to December 31, 2015 were analyzed, and according to the clinical outcome, the patients were divided into a MODS group （88 cases） and a non-MODS group （87 cases）. The general situation of patients, the results of various examinations and laboratory tests, injury severity score （ISS）, new ISS （NISS）, sequential organ failure assessment （SOFA） score, glasgow coma scores （GCS） and acute physiological and chronic healthy evaluation ]1 （APACHE 11 ） score were carried out and compared between the two groups. The indicator with statistical significance obtained from univariate analysis was brought into the multivariate Logistic regression analysis to screen out the independent risk factors that might affect the development of MODS in traumatic patients; the receiver operating characteristic curve （ROC curve） was drawn to calculate the area under ROC curve （AUC） and the predictive value of the severe traumatic patients＇ early warning scoring system for MODS onset was assessed. Results In the enrolled 175 cases, the incidence of MODS and acute respiratory distress syndrome （ARDS） were 50.29% （88/175） and 53.71% （94/175）, respectively, and the mortality was 17.71% （31/175）. Compared with the non-MODS group, the patients with MODS had higher probabilities of occurrences of atrial fibrillation （AF）, central venous catheterization, endotracheal intubation, and the incidences of infection, ARDS, and post-traumatic coagulopathy were also higher than those in the non-MODS group, the hospitalization duration, SOFA score and inhaled oxygen concentration （FiO2）were higher in MODS group; while t
作者
李兴杰
孙宇
殷商启
易昱昊
黄文娟
梁华平
Li Xingfie;Sun Yu;Yin Shangqi;Yi Yuhao;Huang Wenjuan;Liang Huaping(The Party Branch,the Liangping District People＇s Hospital of Chongqing City,Chongqing 405200,China;First Department,Institute of Surgery,Daping Hospital,Army Military Medical University,Chongqing 400042,China)
出处
《中国中西医结合急救杂志》
CAS
CSCD
北大核心
2018年第4期358-362,共5页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
全军后勤科研计划项目（BWS11J038）
