六种评分系统对ICU严重创伤患者预后的预测价值比较与前瞻性验证研究

发布时间：2018-07-01 09:53

本文选题：严重创伤 + 预后　；参考：《成都医学院》2017年硕士论文

【摘要】：目的回顾性分析新损伤严重度评分(NISS)、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、格拉斯哥昏迷评分(GCS)、NISS联用GCS、APACHEⅡ联用GCS、NISS联用APACHEⅡ对ICU严重创伤患者不良预后的预测价值,并进行前瞻性验证。方法回顾性收集2010年1月至2014年12月成都医学院附属第一医院、第三军医大学大坪医院、遵义医学院附属医院入住重症加强护理病房(ICU)的614例严重创伤患者临床资料,记录患者发生MODS与死亡的情况,计算并比较MODS组(420例)、非MODS组(194例)、死亡组(150例)与存活组(464例)入住ICU首日的NISS、APACHEⅡ、NGCS(校正后的GCS)、NISS+NGCS、APACHEⅡ+NGCS、NISS+APACHEⅡ评分。于2015年4月至2016年8月在第三军医大学大坪医院、遵义医学院附属医院对238例符合条件的严重创伤患者开展前瞻性验证研究,记录患者发生脓毒症、MODS与死亡的情况,计算并比较脓毒症组(98例)、非脓毒症组(80例)、MODS组(162例)、非MODS组(76例)、死亡组(65例)与存活组(173例)入住ICU首日的NISS、APACHEⅡ、NGCS、NISS+NGCS、APACHEⅡ+NGCS、NISS+APACHEⅡ评分。对数据进行t检验、χ2检验,分别绘制614例与238例患者各评分系统的受试者工作特征曲线(ROC),并采用DeLong-De Long非参数法检验,分析其对创伤患者不良结局的预测价值。结果(1)回顾性分析结果:MODS组与死亡组的NISS、APACHEⅡ、NGCS、NISS+NGCS、APACHEⅡ+NGCS、NISS+APACHEⅡ评分均明显高于未发生MODS组与治愈组(P0.05)。NISS、APACHEⅡ、NGCS、NISS+NGCS、APACHEⅡ+NGCS、NISS+APACHEⅡ预测614例严重创伤患者并发2个及以上受罹器官MODS的ROC曲线下面积依次为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);预测并发3个及以上受罹器官mods的roc曲线下面积依次为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);预测并发4个及以上受罹器官mods的roc曲线下面积依次为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);预测死亡的roc曲线下面积依次为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)前瞻性验证结果:脓毒症组、mods组与死亡组的niss、apacheii、ngcs、niss+ngcs、apacheii+ngcs、niss+apacheii评分均明显高于未发生脓毒症组、未发生mods组与治愈组(p0.05)。niss、apacheii、ngcs、niss+ngcs、apacheii+ngcs、niss+apacheii预测238例严重创伤患者并发脓毒症的roc曲线下面积依次为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);预测并发2个及以上受罹器官mods的roc曲线下面积依次为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);预测并发3个及以上受罹器官mods的roc曲线下面积依次为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);预测并发4个及以上受罹器官mods的roc曲线下面积依次为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);预测死亡的roc曲线下面积依次为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)。结论niss+apacheii在预测icu严重创伤患者并发脓毒症、mods与死亡的能力中优于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,差异有统计学意义)。
[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).
【学位授予单位】：成都医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R641

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