解剖学评分联合生理学评分对严重创伤患者并发多器官功能障碍综合征的预测价值

马晓媛; 肖雅; 陈涛; 蒋东坡; 周健; 严军; 梁华平

doi:10.3760/cma.j.issn.1009-2587.2016.02.009

解剖学评分联合生理学评分对严重创伤患者并发多器官功能障碍综合征的预测价值

doi: 10.3760/cma.j.issn.1009-2587.2016.02.009

1. 610500 成都医学院基础医学院;
2. 第三军医大学大坪医院野战外科研究所,创伤、烧伤与复合伤国家重点实验室;
3. 遵义医学院附属医院重症医学科

基金项目:

2011年度全军后勤科研计划（BWS11J038）

国家重点基础研究发展计划（973计划）（2012CB518102）

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出版历程
- 收稿日期: 2015-10-14
- 网络出版日期: 2021-10-28
- 刊出日期: 2016-02-20

Predictive value of combining of anatomy scoring system and physiological scoring system for the diagnosis of multiple organ dysfunction syndrome in patients with severe trauma

1. School of Basic Medicine, Chengdu Medical College, Chengdu 610500, China

摘要

摘要: 目的评价解剖学评分联合生理学评分对严重创伤患者并发MODS的预测价值。方法 2010年1月—2014年12月，成都医学院第一附属医院、第三军医大学大坪医院、遵义医学院附属医院ICU共收治539例符合入选标准的严重创伤患者，对其临床资料进行回顾性分析。根据是否并发MODS将患者分为MODS组361例与非MODS组178例，计算并比较2组患者入住ICU首日的损伤严重程度评分(ISS)、新损伤严重程度评分(NISS)、急性生理与慢性健康评估Ⅱ(APACHEⅡ)评分、ISS＋APACHEⅡ评分和NISS＋APACHEⅡ评分。对数据行t检验、χ²检验，绘制539例患者各评分系统的受试者工作特征(ROC)曲线，并用DeLong-DeLong非参数法检验，分析其对MODS的预测价值。结果 MODS组患者的ISS、NISS、APACHEⅡ评分、ISS＋APACHEⅡ评分、NISS＋APACHEⅡ评分分值分别为(26±8)、(36±12)、(21±7)、(47±10)、(56±14)分，均明显高于非MODS组的(24±6)、(28±7)、(16±5)、(39±8)、(44±9)分(t值为4.970～12.120，P值均小于0.01)。ISS、NISS、APACHEⅡ评分、ISS＋APACHEⅡ评分、NISS＋APACHEⅡ评分在预测严重创伤患者并发MODS时的ROC曲线下总面积(95%置信区间)分别为0.611(0.569～0.653)、0.693(0.652～0.731)、0.719(0.679～0.756)、0.727(0.687～0.764)、0.764(0.726～0.799)。NISS、APACHEⅡ评分、ISS＋APACHEⅡ评分、NISS＋APACHEⅡ评分的ROC曲线下总面积均明显大于ISS(Z值为3.505～7.179，P值均小于0.001)。APACHEⅡ评分、ISS＋APACHEⅡ评分的ROC曲线下总面积大于NISS，但差异均无统计学意义(Z值分别为0.931、1.657，P值均大于0.05)；NISS＋APACHEⅡ评分的ROC曲线下总面积明显大于NISS(Z＝5.478，P<0.001)。ISS＋APACHEⅡ评分的ROC曲线下总面积大于APACHEⅡ评分，但差异无统计学意义(Z＝0.450，P＝0.653)；NISS＋APACHEⅡ评分的ROC曲线下总面积明显大于APACHEⅡ评分(Z＝2.554，P<0.05)。NISS＋APACHEⅡ评分的ROC曲线下总面积明显大于ISS＋APACHEⅡ评分(Z＝2.989，P<0.01)。结论 NISS＋APACHEⅡ评分较ISS、NISS、APACHEⅡ评分、ISS＋APACHEⅡ评分对严重创伤患者并发MODS具有更好的预测价值。
- 创伤和损伤 /
- 多器官功能衰竭 /
- 损伤严重程度评分 /
- 新损伤严重程度评分 /
- 急性生理与慢性健康评估Ⅱ
Abstract: Objective To evaluate the predictive value of a combination of anatomy scoring system and physiological scoring system for the diagnosis of multiple organ dysfunction syndrome (MODS) in patients with severe trauma. Methods The clinical data of 539 patients with severe trauma hospitalized in ICUs of the First Affiliated Hospital of Chengdu Medical College, Daping Hospital of the Third Military Medical University, and the Affiliated Hospital of Zunyi Medical College from January 2010 to December 2014, conforming to the study criteria, were retrospectively analyzed. The patients were divided into MODS group (n=361) and non-MODS group (n=178) according to the diagnostic criteria of MODS. The data of Injury Severity Score (ISS), New Injury Severity Score (NISS), Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score, ISS+ APACHE Ⅱ score, and NISS+ APACHE Ⅱ score of patients on the first day of ICU admission were calculated and compared between the two groups. Data were processed with t test, chi-square test, and receiver operating characteristic (ROC) curves of the various scoring systems in 539 patients with severe trauma were plotted, and DeLong-DeLong non parametric test was used to evaluate the predictive ability for MODS of the various scoring systems. Results The scores of ISS, NISS, APACHE Ⅱ, ISS+ APACHE Ⅱ, and NISS+ APACHE Ⅱ of patients in MODS group were respectively (26±8), (36±12), (21±7), (47±10), and (56±14) points, and they were significantly higher than those of patients in non-MODS group [respectively (24±6), (28±7), (16±5), (39±8), and (44±9) points, with t values from 4.970 to 12.120, P values below 0.01]. The total areas under ROC curves (95% confidence interval) of ISS, NISS, APACHE Ⅱ score, ISS+ APACHE Ⅱ score, and NISS+ APACHE Ⅱ score in MODS prediction of patients with severe trauma were respectively 0.611 (0.569-0.653), 0.693 (0.652-0.731), 0.719 (0.679-0.756), 0.727 (0.687-0.764), and 0.764 (0.726-0.799). The total areas under ROC curves of NISS, APACHE Ⅱ score, ISS+ APACHE Ⅱ score, and NISS+ APACHE Ⅱ score were significantly larger than the total area under ROC curve of ISS (with Z values from 3.505 to 7.179, P values below 0.001). The total areas under ROC curves of APACHE Ⅱ score and ISS+ APACHE Ⅱ score were larger than the total area under ROC curve of NISS, but there were no significant differences (with Z values respectively 0.931 and 1.657, P values above 0.05), while the total area under ROC curve of NISS+ APACHE Ⅱ score was significantly larger than that of NISS (Z=5.478, P<0.001). The total area under ROC curve of ISS+ APACHE Ⅱ score was larger than that of APACHEⅡ score, but there was no significant difference (Z=0.450, P=0.653), and the total area under ROC curve of NISS+ APACHE Ⅱ score was significantly larger than that of APACHE Ⅱ score (Z=2.554, P<0.05). The total area under ROC curve of NISS+ APACHE Ⅱ score was significantly larger than that of ISS+ APACHE Ⅱ score (Z=2.989, P<0.01). Conclusions The combination of NISS and APACHE Ⅱ score is more significant than ISS, NISS, APACHE Ⅱ score, and ISS+ APACHE Ⅱ score in prediction of MODS in patients with severe trauma.
- Wounds and injuries /
- Multiple organ failure /
- Injury Severity Score /
- New Injury Severity Score /
- Acute Physiology and Chronic Health Evaluation Ⅱ