摘要
目的:探讨初始血糖联合APACHEⅡ评分对急性创伤患者短期预后的评估价值及初始血糖与初始血乳酸的相关性。方法:收集2017年1月—12月东部战区总医院急诊抢救室收治的940例诊断为急性创伤的患者临床资料,根据治疗结局分为生存组与死亡组,回顾性分析并比较各组基本生命体征、初始血糖值、初始血乳酸、APACHEⅡ评分、抢救天数、重症监护室天数、住院天数、28 d病死率、急诊处理、患者去向等指标,同时研究初始血糖联合APACHEⅡ评分在急性创伤患者短期预后中的意义,并分析初始血糖与初始血乳酸间的相关性。结果:存活组患者的初始血糖值显著小于死亡组[6.9(5.9,8.6)mmol/L vs.11.0(9.7,15.6)mmol/L,P<0.01],初始血乳酸水平也显著低于死亡组[1.5(1.0,2.5)mmol/L vs.4.7(2.5,7.2)mmol/L,P<0.01];初始血糖联合APACHEⅡ评分对急性创伤患者预后的评估能力(AUC=0.901)优于单独初始血糖(AUC=0.873)或单独APACHEⅡ评分(AUC=0.856);急性创伤患者初始血糖与初始乳酸水平呈正相关(r=0.448,P<0.01)。结论:初始血糖值联合APACHEⅡ评分对急性创伤患者病情严重程度及短期预后有较好的评估价值,有利于急性创伤患者病情的早期识别并尽早处理以改善预后。
Objective: To explore the evaluation value of initial blood glucose combined with APACHE Ⅱ score on the short-term prognosis of patients with acute injury as well as the correlation between initial blood glucose and initial blood lactate. Methods: The clinical data of 940 patients diagnosed with acute trauma admitted to the Department of Emergency Medicine, General Hospital of Eastern Theater Command from January 2017 to December 2017 were collected. According to the outcome, they were divided into survival group and death group. The basic vital signs, initial blood glucose level, initial blood lactate, APACHE Ⅱ score, rescue days, intensive care unit days, hospitalization days, 28-day fatality rate, emergency treatment, patient whereabouts and other indicators of each group were retrospectively analyzed and compared. The significance of combined APACHE Ⅱ score in the short-term prognosis of patients with acute trauma, and the correlation between initial blood glucose and initial blood lactate was analyzed. Results: The initial blood glucose level of the survival group was significantly lower than that of the death group(6.9[5.9, 8.6]mmol/L vs. 11.0[9.7, 15.6]mmol/L, P<0.01), and the initial blood lactate level of the survival group was also significantly lower than that of the death group(1.5[1.0, 2.5]mmol/L vs. 4.7[2.5, 7.2] mmol/L, P<0.01);The ability of initial blood glucose combined with APACHE Ⅱ score to assess the prognosis of acute trauma(AUC=0.901) is better than initial blood glucose alone(AUC=0.873) or APACHE Ⅱ score alone(AUC=0.856);the initial blood glucose of acute trauma patients is positively correlated with the initial lactate level(r=0.448, P<0.01). Conclusion: The initial blood glucose combined with APACHE Ⅱ score has a good evaluation value for the severity of acute patients of trauma and the short-term prognosis. which was beneficial for the early identification to promote the diagnose and the early treatment to improve the prognosis.
作者
张鹏
王蒙蒙
孙兆瑞
曹丽萍
任艺
庄苏园
董妍
聂时南
ZHANG Peng;WANG Mengmeng;SUN Zhaorui;CAO Liping;REN Yi;ZHUANG Suyuan;DONG Yan;NIE Shinan(Graduate School of Wannan Medical College,Wuhu,Anhui,241000,China;Department of Emergency Medicine,General Hospital of Eastern Theater Command,PLA)
出处
《临床急诊杂志》
CAS
2021年第4期241-246,共6页
Journal of Clinical Emergency
基金
南京市医学重点专科(No:SZDZK2016010)
军队医学科技青年培育计划项目(No:21QNPY120)
中国博士后科学基金面上项目(No:2020M683718)。
