创伤评分在腹部创伤结局预测中预测效果分析

发布时间：2018-04-14 23:08

本文选题：腹部创伤 + 创伤评分　；参考：《山西医科大学》2013年硕士论文

【摘要】：目的： 1．了解晋城市近5年腹部创伤患者的年龄构成、致伤机制、损伤脏器构成、院内救治时间、救治结局等情况，从而对于腹部创伤的发生原因、规律以及危险因素作出全面客观的认识，进而有利于制定和调整相应救治策略及预防措施，合理分配有限的医疗资源，规范救治流程，从根本上提高腹部创伤的救治水平。 2．应用本数据库资料，判断各评分系统对本地区腹部创伤救治病死率的评估效果和预测价值，筛选效能较高的创伤评分预测模型及较合理的参数指标。 3.以AIS-2005为解剖评分基础，探索建立用于腹部创伤院内救治的创伤结局预测模型，并检验其应用效能。方法： 1.回顾性分析晋煤集团总医院和所属六所矿医院2008年1月1日——2013年1月31日共5年收治的创伤病例。按照多因素分析样本量n至少是变量m的5～10倍的基本原则，本研究的最少样本是100；根据相关文献查询，腹部创伤患者中生存人数远多于死亡人数，因本次研究共收集死亡病例数22人，综合考虑，本次研究按照死亡：生存=1:4的比例从所有生存患者中随机抽取88人进行统计分析，其达到统计学要求的样本数量。 2.以生死结局分组，比较两组患者入院时和麻醉前各种生理参数及各种评分系统在生死结局中的异同。生理评分包括：GCS、T-RTS、RTS、CRAMS；院内评分包括ISS、NISS和以ISS和NISS为基础计算的PS。 3.以生死结局分组，通过对患者入院时及麻醉前各项生理参数的统计分析，选取有统计学意义的指标作为新评分参数，并利用Logistic回归的方法计算各参数的权重系数，由此得出新评分方法的数学模型。新评分方法暂命名为腹部创伤记分(revisedtraumascoreofabdomen)记为RTSA。结合ISS及年龄，将每例患者的RTS和RTSA值代入TRISS公式计算PS，从而比较并评价RTSA和RTS对腹部创伤患者生死结局的预测效果。 4.腹部创伤新评分的评价：将RTS和RTSA值分别代入TRISS公式计算PS，通过两种模型在预测的生／死同实际生／死的比较，评价各自创伤预测模型的敏感性、特异性、区别度、准确性、死亡误判率及生存误判率。结果： 1.腹部创伤患者ISS评分分值越低则其实际病死率越低，目前争议的以16亦或以20作为创伤严重度界值，通过本试验分析未提示有统计学意义，其χ2值为0.025，P值为0.874。 2.生理评分中，存活组GCS、T-RTS、RTS、CRAMS高于死亡组：院内评分中，存活组ISS、NISS小于死亡组；以ISS和NISS为基础计算的PS在存活组亦高于死亡组，但两组预测结果在比较验证伤情效能和预测近期死亡的能力差别不大。 3.RTSA模型的非线性回归方程入院时RTSA=6.0657G+2.3474S+1.2020M-29.1055麻醉前RTSA=2.3788G+1.9523S+3.1833M-21.9931 4.RTSA模型较既往的TRISS模型，其预测结果的准确性及特异度变化不大，但显著提高了生死结局预测的区别度和敏感性，同时降低了死亡误判率。结论： 1．本组样本初步反映了本地区国人腹部创伤的流行病学特点，数据资料对建立国人MTOS数据库具有一定价值。 2．创伤评分预测模型是对腹部创伤患者损伤严重程度和结局进行评估的有效方法。通过本次以腹部损伤为主的资料分析，在实际存活、死亡组间，各创伤评分系统的预测能力均存在差异，提示创伤评分有助于准确、可靠的对创伤患者进行伤情评估和结局预测。 3．通过不同创伤评分预测模型的应用效果对比分析，可以筛选出更为合理、科学的指标参数和效能较高的评分预测模型。 4．根据本数据库建立的RTSA模型，更适合本地区国人的腹部创伤结局预测，建议在本地区推广使用。但RTSA模型在其他地区的应用效果如何，需进一步检验和对比。
[Abstract]:Objective:
1. understanding of Jincheng city in recent 5 years of abdominal trauma patients age, mechanism of injury, organ damage, hospital treatment time, treatment outcome, and the causes of abdominal trauma, regularity and risk factors make an objective understanding, which is conducive to making appropriate adjustments and treatment strategies and preventive measures. The reasonable distribution of the limited medical resources, standardize the treatment procedure, fundamentally improve the level of treatment of abdominal trauma.
2., we applied the database data to judge the evaluation effect and predictive value of each scoring system on the mortality rate of abdominal trauma treatment in our area, and screened a high effective trauma score prediction model and a reasonable parameter index.
3. based on the anatomical basis of AIS-2005, a prediction model of trauma outcome was established for the treatment of abdominal trauma and its application effectiveness was tested.
Method:
A retrospective analysis of 1. Shanxi coal group general hospital and affiliated hospital in January 1, 2008 six - 31 January 2013, mine 5 years from trauma cases. According to multivariate analysis sample n is at least 5~10 times the basic principle of variable m, at least the research sample is 100; according to Xiang Guanwen Xian query, abdominal trauma patients survival far more than the number of deaths, the study collected the number of deaths of 22 people, a comprehensive consideration, this study according to the death: survival ratio of =1:4 for statistical analysis were randomly selected from all patients living in 88 people, the number of samples reached statistical requirements.
2., according to life and death outcomes, the similarities and differences between two groups of patients in admission and before anesthesia and various scoring systems in life and death outcomes were compared. Physiological scores include GCS, T-RTS, RTS and CRAMS, and hospital scores include ISS, NISS and PS. calculated based on ISS and NISS.
3. death outcome groups, through the statistical analysis of patients before anesthesia and various physiological parameters, selection of the indicators were statistically significant as new scoring parameters, weight coefficient and calculate the parameters by using Logistic regression model, the new scoring method. The number of the new scoring method named abdominal trauma score (revisedtraumascoreofabdomen) RTSA. as the combination of ISS and age, each patient's RTS and RTSA values of TRISS formula PS, to compare and evaluate the prediction effect of RTSA and RTS on abdominal trauma patients between life and death.
Evaluation of 4. new abdominal trauma score: RTS and RTSA respectively by TRISS formula PS, the two models in the prediction of life and death compared with the actual birth / death, evaluated their trauma model sensitivity, specificity, accuracy, degree of differentiation, the death rate of miscarriage of justice and survival rate of misjudgment.
Result:
1., the lower the ISS score of abdominal trauma is, the lower the actual mortality is. The current controversy is 16 or 20 as the boundary value of trauma severity. It is not indicated by this experimental analysis that the chi square value is 0.025, and the P value is 0.874..
2. physiological score, survival group GCS, T-RTS, RTS, CRAMS higher than the death group: hospital score, survival group ISS, less than NISS ISS and NISS in the death group; based on the calculation of the PS in the survival group was also higher than the death group, but the two group forecast results in comparison to verify effectiveness and prediction of recent little injury different abilities of death.
Nonlinear regression equation of 3.RTSA model before RTSA=6.0657G+2.3474S+1.2020M-29.1055 anaesthesia at the time of admission to RTSA=2.3788G+1.9523S+3.1833M-21.9931
Compared with the previous TRISS models, the 4.RTSA model has little change in accuracy and specificity, but significantly improves the difference and sensitivity of prediction of life and death outcomes, and reduces the rate of miscarriage of death.
Conclusion:
1. this group of samples preliminarily reflects the epidemiological characteristics of abdominal trauma in the local people, and the data are of certain value to the establishment of the national MTOS database.
2. trauma score prediction model is a feasible method for patients with abdominal trauma injury severity and outcome evaluation. Through the analysis of the data with abdominal injury, in the actual survival and death group, there were differences in prediction ability of the trauma score system, suggesting that the trauma score contributes to accurate and reliable injury assessment and in predicting the outcome of trauma patients.
3., by comparing and analyzing the application effect of different trauma score prediction models, we can screen out a more reasonable and scientific index parameter and a higher score prediction model.
4. according to the RTSA model established in this database, it is more suitable for the prediction of abdominal trauma outcomes of Chinese people in the region. It is recommended to be popularized in this area. However, the application effect of RTSA model in other areas needs further examination and comparison.

【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R641

【参考文献】