穿透性心脏损伤严重程度分级与临床特征的关系

Correlation of Clinical Characteristics and Outcomes with Organ Injury Scaling in Penetrating Cardiac Trauma

目的采用器官损伤分级(organ injury scale,OIS)标准,评价穿透性心脏损伤严重程度与临床特征及预后间的关系. 方法对224例急诊手术治疗的穿透性心脏损伤患者进行回顾性分析,分析OIS与临床分型、临床特征、格拉斯哥昏迷指数(GCS)、ISS、穿透性胸部创伤指数(PTTI)、穿透性创伤指数(PTI)等创伤评分及预后之间的关系. 结果穿透性心脏损伤患者多为OIS Ⅳ级和Ⅴ级,Ⅰ～Ⅲ级患者多为亚临床型,而Ⅳ～Ⅵ级患者以心脏压塞型和失血性休克型为主.OIS与伤后时间、入院时GCS呈显著负相关(r＝-0.18,-0.16),而与输血量、ISS、PTTI、PTI、死亡例数等呈显著正相关(r＝0.17,0.22,0.40,0.41,0.29). 结论 OIS与穿透性心脏损伤临床特征以及预后显著相关,有助于对预后的评价.

Objective To evaluate the relationship of the organ injury scale （OIS） with clinical characteristics and survival in penetrating cardiac trauma patients. Methods A retrospective review identified 224 patients with penetrating cardiac trauma. A grade assigned on the basis of the American Association for the Surgery of Trauma OIS was assigned to each case studied. Clinical data, including Glasgow coma scale（GCS）, revised trauma score（RTS）, injury severity score （ISS）, penetrating thoracic trauma index （PTTI）, penetrating trauma index （PTI）, and outcomes were analyzed for association with OIS grade. Results The majority of patients were either grade Ⅳ/ or Ⅴ , with grade Ⅵ having the highest mortality. Patients of grade Ⅰ to Ⅲ were mostly Sub-clinical type patients, and grade Ⅳ to Ⅵ were mostly pericardial tamponade type and hemorrhagic shock type patients. The OIS grade was significantly negative correlated with postinjury duration and GCS （r=-0. 18, -0.16）, and positive correlated with transfusion, ISS, PTTI, PT1, and death（r=0. 17,0. 22,0. 40,0. 41,0. 29）. Conclusion The OIS appears to correlate with severity of injury and survival, and it may be useful in predicting outcomes in patients with penetrating cardiac injury.