创伤脓毒症风险预警诊断和预后评估模型建立与评价

被引：11

作者：

杨建华 ^{[1
]}

王旭 ^{[1
]}

张安强 ^{[2
]}

黄宏 ^{[2
]}

曾灵 ^{[2
]}

王枭 ^{[2
]}

陆红祥 ^{[2
]}

文大林 ^{[2
]}

蒋建新 ^{[1
,2
]}

机构：

[1] 温州医科大学附属第一医院急诊科

[2] 第三军医大学大坪医院野战外科研究所第四研究室, 创伤、烧伤与复合伤国家重点实验室

来源：

中华创伤杂志 | 2017年 / 05期

关键词：

脓毒症; 诊断, 鉴别; 预后;

D O I：

暂无

中图分类号：

R641 [创伤];

学科分类号：

100227 [皮肤病学];

摘要：

目的联合临床常用的检测指标和生物评分构建脓毒症早期预警诊断和预后评估模型, 并探讨模型预警及预后评估的价值。方法采用回顾性对照研究分析2010年1月— 2016年5月收治的209例严重创伤患者的临床资料, 采集入院当天、伤后3, 5, 7 d患者的白细胞计数、淋巴细胞计数及百分数、单核细胞计数及百分数、中性粒细胞计数及百分数、中性粒细胞计数与淋巴细胞计数的比值(N/L)以及入院当天的急性生理和慢性健康评估Ⅱ(APACHEⅡ)评分、感染相关序贯性脏器功能衰竭评分(SOFA)和改良早期预警评分(MEWS)、格拉斯哥昏迷评分(GCS)、多器官功能障碍综合征(MODS)评分、乳酸(LAC)等数据, 构建早期预警的加权模型和预后评估的生物评分模型, 并应用受试者工作特征(ROC)计算曲线下面积(AUC), 评价其在脓毒症预警诊断和预后评估中的效果。结果入院当天, 由APACHEⅡ评分、SOFA和MEWS联合的加权模型AUC为0.729。伤后3 d炎性细胞联合加权诊断模型AUC为0.680, 生物评分AUC为0.800, 差异有统计学意义(P<0.05)。伤后5 d炎性细胞联合加权诊断模型AUC为0.789, 生物评分AUC为0.812, 差异有统计学意义(P<0.05)。伤后7 d炎性细胞联合加权诊断模型AUC为0.706, 生物评分AUC为0.713, 差异无统计学意义(P>0.05)。伤后3, 5 d的生物评分AUC差异有统计学意义(P<0.05)。由APACHEⅡ评分、MODS评分、GCS和LAC联合的加权模型应用于脓毒症预后评估时, 入院当天的AUC为0.838, 伤后3 d的AUC为0.878, 伤后5 d的AUC为0.947, 伤后7 d的AUC为0.936。入院当天、伤后3, 5, 7 d的AUC差异有统计学意义(P<0.05)。结论伤后3 d的生物评分对脓毒症有较好的早期预警效果。伤后5 d由APACHEⅡ评分、MODS评分、GCS和LAC联合的加权模型能有效预测脓毒症患者的预后。

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