本文選題：嚴重創(chuàng)傷 + 預(yù)后��； 參考：《成都醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的回顧性分析新?lián)p傷嚴重度評分(NISS)、急性生理學(xué)與慢性健康狀況評分Ⅱ(APACHEⅡ)、格拉斯哥昏迷評分(GCS)、NISS聯(lián)用GCS、APACHEⅡ聯(lián)用GCS、NISS聯(lián)用APACHEⅡ?qū)CU嚴重創(chuàng)傷患者不良預(yù)后的預(yù)測價值,并進行前瞻性驗證。方法回顧性收集2010年1月至2014年12月成都醫(yī)學(xué)院附屬第一醫(yī)院、第三軍醫(yī)大學(xué)大坪醫(yī)院、遵義醫(yī)學(xué)院附屬醫(yī)院入住重癥加強護理病房(ICU)的614例嚴重創(chuàng)傷患者臨床資料,記錄患者發(fā)生MODS與死亡的情況,計算并比較MODS組(420例)、非MODS組(194例)、死亡組(150例)與存活組(464例)入住ICU首日的NISS、APACHEⅡ、NGCS(校正后的GCS)、NISS+NGCS、APACHEⅡ+NGCS、NISS+APACHEⅡ評分。于2015年4月至2016年8月在第三軍醫(yī)大學(xué)大坪醫(yī)院、遵義醫(yī)學(xué)院附屬醫(yī)院對238例符合條件的嚴重創(chuàng)傷患者開展前瞻性驗證研究,記錄患者發(fā)生膿毒癥、MODS與死亡的情況,計算并比較膿毒癥組(98例)、非膿毒癥組(80例)、MODS組(162例)、非MODS組(76例)、死亡組(65例)與存活組(173例)入住ICU首日的NISS、APACHEⅡ、NGCS、NISS+NGCS、APACHEⅡ+NGCS、NISS+APACHEⅡ評分。對數(shù)據(jù)進行t檢驗、χ2檢驗,分別繪制614例與238例患者各評分系統(tǒng)的受試者工作特征曲線(ROC),并采用DeLong-De Long非參數(shù)法檢驗,分析其對創(chuàng)傷患者不良結(jié)局的預(yù)測價值。結(jié)果(1)回顧性分析結(jié)果:MODS組與死亡組的NISS、APACHEⅡ、NGCS、NISS+NGCS、APACHEⅡ+NGCS、NISS+APACHEⅡ評分均明顯高于未發(fā)生MODS組與治愈組(P0.05)。NISS、APACHEⅡ、NGCS、NISS+NGCS、APACHEⅡ+NGCS、NISS+APACHEⅡ預(yù)測614例嚴重創(chuàng)傷患者并發(fā)2個及以上受罹器官MODS的ROC曲線下面積依次為0.693(0.655~0.731)、0.701(0.663~0.737)、0.681(0.642~0.701)、0.689(0.650~0.725)、0.709(0.670~0.743)、0.732(0.695~0.767);預(yù)測并發(fā)3個及以上受罹器官mods的roc曲線下面積依次為0.710(0.672~0.746)、0.727(0.691~0.761)、0.693(0.655~0.730)、0.723(0.685~0.758)、0.737(0.701~0.770)、0.779(0.744~0.811);預(yù)測并發(fā)4個及以上受罹器官mods的roc曲線下面積依次為0.714(0.675~0.751)、0.732(0.701~0.770)、0.683(0.645~0.720)、0.698(0.660~0.734)、0.738(0.703~0.771)、0.798(0.756~0.825);預(yù)測死亡的roc曲線下面積依次為0.826(0.794~0.855)、0.802(0.768~0.832)、0.808(0.774~0.838)、0.859(0.829~0.886)、0.864(0.835~0.890)、0.896(0.869~0.919)。(2)前瞻性驗證結(jié)果:膿毒癥組、mods組與死亡組的niss、apacheii、ngcs、niss+ngcs、apacheii+ngcs、niss+apacheii評分均明顯高于未發(fā)生膿毒癥組、未發(fā)生mods組與治愈組(p0.05)。niss、apacheii、ngcs、niss+ngcs、apacheii+ngcs、niss+apacheii預(yù)測238例嚴重創(chuàng)傷患者并發(fā)膿毒癥的roc曲線下面積依次為0.687(0.651~0.722)、0.710(0.673~0.747)、0.663(0.624~0.701)、0.695(0.653~0.731)、0.716(0.678~0.752)、0.747(0.710~0.781);預(yù)測并發(fā)2個及以上受罹器官mods的roc曲線下面積依次為0.715(0.653~0.771)、0.637(0.572~0.698)、0.721(0.668~0.787)、0.739(0.680~0.791)、0.729(0.664~0.783)、0.777(0.718~0.828);預(yù)測并發(fā)3個及以上受罹器官mods的roc曲線下面積依次為0.704(0.642~0.761)、0.668(0.605~0.728)、0.714(0.655~0.767)、0.742(0.682~0.796)、0.739(0.678~0.793)、0.774(0.715~0.827);預(yù)測并發(fā)4個及以上受罹器官mods的roc曲線下面積依次為0.690(0.627~0.748)、0.719(0.658~0.775)、0.739(0.682~0.791)、0.740(0.679~0.795)、0.743(0.685~0.796)、0.782(0.725~0.833);預(yù)測死亡的roc曲線下面積依次為0.696(0.630~0.747)、0.687(0.630~0.748)、0.701(0.638~0.758)、0.712(0.650~0.767)、0.672(0.609~0.731)、0.748(0.688~0.802)。結(jié)論niss+apacheii在預(yù)測icu嚴重創(chuàng)傷患者并發(fā)膿毒癥、mods與死亡的能力中優(yōu)于NISS、APACHEⅡ、NGCS、NISS+NGCS、APACHEⅡ+NGCS(NISS+APACHEⅡ vs.NISS,NISS+APACHEⅡ vs.APACHEⅡ,NISS+APACHEⅡ vs.NGCS,NISS+APACHEⅡ vs.NISS+NGCS,NISS+APACHEⅡ vs.APACHEⅡ+NGCS,P均小于0.05,差異有統(tǒng)計學(xué)意義)。
[Abstract]:Objective to review the retrospective analysis of the new damage severity score (NISS), acute physiological and chronic health status score II (APACHE II), Glasgow coma score (GCS), NISS combined with GCS, APACHE II combined with GCS, and NISS combined with APACHE II for the bad prognosis of patients with ICU severe trauma, and prospectively verified. Methods retrospective collection of 1 2010. From January to December 2014, the first hospital of the Chengdu Medical College, the Daping Hospital of the Chengdu Medical College, Daping Hospital of Third Military Medical University, 614 cases of severe trauma patients admitted to the intensive care unit (ICU), recorded the cases of patients with MODS and death, calculated and compared the MODS group (420 cases), non MODS group (194 cases), death group (150 cases) and deposit. The living group (464 cases) was admitted to ICU on the first day of NISS, APACHE II, NGCS (corrected GCS), NISS+NGCS, APACHE II +NGCS, and NISS+APACHE II score. From April 2015 to August 2016 in Daping Hospital of Third Military Medical University, 238 patients with severe trauma were prospectively studied to record the patient's sepsis. Disease, MODS and death, calculated and compared the sepsis group (98 cases), non septic group (80 cases), group MODS (162 cases), non MODS group (76 cases), death group (65 cases) and survival group (173 cases) in NISS, APACHE II, NGCS, NISS+NGCS, APACHE II +NGCS, NISS+APACHE II score on the first day of ICU. The data were tested by t test and Chi Chi test, 614 cases and 238 cases respectively. 238 cases were drawn and 238 cases were drawn respectively. The subjects' working characteristic curve (ROC) of the patient's scoring system and the DeLong-De Long nonparametric test were used to analyze the predictive value of the patient's bad outcome in trauma patients. Results (1) the results of the retrospective analysis were: NISS, APACHE II, NGCS, NISS+NGCS, APACHE II +NGCS, NISS+APACHE II score of MODS and death groups were significantly higher than those without MODS. Group and cure group (P0.05).NISS, APACHE II, NGCS, NISS+NGCS, APACHE II +NGCS, NISS+APACHE II predicted that the area under the ROC curve of 614 patients with severe trauma was 0.693 (0.655~0.731), 0.701 (0.663~0.737), 0.681 (0.701), 0.689 (0.701), 0.709, 0.732 (0.732); The area under the ROC curve of 3 and more infected mods was 0.710 (0.672~0.746), 0.727 (0.691~0.761), 0.693 (0.655~0.730), 0.723 (0.685~0.758), 0.737 (0.701~0.770), 0.779 (0.744~0.811), and the area of ROC curve under the ROC curve of 4 and above was 0.714 (0.675~0.751), 0.732 (0.701~0.770), 0.683 (0.645). ~0.720), 0.698 (0.660~0.734), 0.738 (0.703~0.771), 0.798 (0.756~0.825); the area under the ROC curve for predicting death was 0.826 (0.794~0.855), 0.802 (0.768~0.832), 0.808 (0.774~0.838), 0.859 (0.829~0.886), 0.864 (0.835~0.890), 0.896 (0.869~0.919). (2): sepsis group, MODS group and death group. The scores of niss+ngcs, apacheii+ngcs, and niss+apacheii were significantly higher than those in the non sepsis group, and there was no MODS and cure group (P0.05).Niss, apacheii, NGCS, niss+ngcs, apacheii+ngcs, and niss+apacheii were predicted in 238 cases of severe trauma patients with sepsis. The area under ROC curves was 0.687, 0.710, 0.663. .701), 0.695 (0.653~0.731), 0.716 (0.678~0.752), 0.747 (0.710~0.781); the area under the ROC curve predicted for 2 and more concurrence with MODS was 0.715 (0.653~0.771), 0.637 (0.572~0.698), 0.721 (0.668~0.787), 0.739 (0.680~0.791), 0.729 (0.664~0.783), 0.777 (0.718~0.828), and predicted concurrence of 3 and above. The area under the line was 0.704 (0.642~0.761), 0.668 (0.605~0.728), 0.714 (0.655~0.767), 0.742 (0.682~0.796), 0.739 (0.678~0.793), 0.774 (0.715~0.827); the area under ROC curves of 4 and more infected mods was 0.690 (0.627 ~0.748), 0.719 (0.658~0.775), 0.739 (0.682~0.791), 0.740 (0.679~0.795), 0.743 (0.679~0.795), 0.743 (0.679~0.795), 0.743 (0.679~0.795), 0.743 (0.679~0.795), 0.743 (0.679~0.795), 0.743 (0.679~0.795), 0.743 (0.679~0.795), 0.743 (0.679~0.795), 0.743 (0.679~0.795), 0.743 (0.679~0.795), 0.743 (0.679~0.795), 0.743 (0.679~0.795), 0.743 (0.679~0.795), 0.743 (0.679~0.795), 0.743 (0.679~0.795), 0.743 (0.679~0.795), 0.743 (0.679~0.795), 0.743 ), 0.782 (0.725~0.833); the area under the ROC curve predicted for death was 0.696 (0.630~0.747), 0.687 (0.630~0.748), 0.701 (0.638~0.758), 0.712 (0.650~0.767), 0.672 (0.609~0.731), 0.748 (0.688~0.802). Conclusion niss+apacheii is superior to NISS, MODS and death in the prediction of ICU severe trauma patients. GCS, APACHE II +NGCS (NISS+APACHE II vs.NISS, NISS+APACHE II vs.APACHE II, NISS+APACHE II vs.NGCS, NISS+APACHE II vs.NISS+NGCS, NISS+APACHE II) were less than 0.05, the difference was statistically significant).
【學(xué)位授予單位】：成都醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R641

【相似文獻】

相關(guān)期刊論文 前10條

1 傅德良;實驗室檢查在原發(fā)性甲狀旁腺機能亢進癥患者中的預(yù)測價值[J];國外醫(yī)學(xué).外科學(xué)分冊;2002年04期

2 鄧學(xué)軍;覃數(shù);;妊娠相關(guān)血漿蛋白A在急性冠狀動脈綜合征中的預(yù)測價值[J];中華老年心腦血管病雜志;2008年01期

3 葉麗;張建華;徐巖;陳旭華;伍夢佐;程自平;陳斌;;非高密度脂蛋白膽固醇水平對急性冠狀動脈綜合征患者事件的預(yù)測價值[J];臨床心血管病雜志;2012年07期

4 孫玉發(fā);衣志勇;蔣知新;范利;李小鷹;李美芹;張波;g，

本文編號：2087391