煤矿瓦斯爆炸伤害院前评分方法研究

Pre-hospital scoring system for evaluation of coal mine gas explosion injury

目的探讨和建立适合煤矿瓦斯爆炸伤害的院前评分方法（respiration，pulse，motor and burn，RPMB）。方法在煤矿创伤院前评分（respiration，pulse and motor，RPM）的基础上，结合煤矿瓦斯爆炸伤的伤情特点，建立RPMB评分方法。选择煤矿瓦斯爆炸伤员251例进行回顾性研究，以入院后ISS≥16分为重伤标准，比较RPMB、RPM、院前指数（prehospital index，PHI）、创伤拣伤标准（trauma triage rule，TTR）对重伤员评价的一致性及漏检率，评价RPMB评分方法在煤矿瓦斯爆炸伤害院前评估中的作用。结果251例瓦斯爆炸伤害患者经院内AIS—ISS评估为重伤员41例，RPMB与AIS—ISS评分方法一致性高（Kappa值=0．985），RPMB、RPM、PHI、TTR对瓦斯爆炸重伤员评估灵敏度分别为97．6％、26．8％、22．0％和17．1％，特异度分别为88．1％、97．6％、87．6％和95．7％。结论RPMB评分方法简单、易行，对煤矿瓦斯爆炸伤员检出率高，值得临床推广应用。

Objective To explore and establish pre-hospital scoring system （respiration, pulse, motor and burn, RPMB ） for evaluation of coal mine gas explosion injury. Methods After analysis of characteristics of blast injury caused by coal mine gas explosion, a new pre-hospital scoring system, RPMB, for evaluation of blast injury was established on the basis of pre-hospital evaluation of coal mine injuries （respiration, pulse and motor, RPM）. From January 2003 to December 2009, 251 patients with blast injury caused by coal mine gas explosion were collected in this study for a retrospective study. ISS≥ 16 points was set as the gold standard for severe wound. All the injuries were assessed by RPMB, RMP, pre-hospital index （PHI） and trauma triage rule （TTR）. The consistency and detection rate of severe wounds were compared. The sensitivity and specificity were also calculated. Results Of 251 patients, 41 patients were evaluated as severe, with high consistency rate between AIS-ISS and RPMB （kappa = 0. 985）. The sensitivity of RPMB, RPM, PHI and TTR was 97.6% , 26.8% , 22. 0% and 17.1% respectively and the specificity of those was 88.1% , 97.6%, 87.6% and 95.7% respectively. Conclusion RPMB is a simple and easy scoring method, with high detection rate of severe wound and potential of clinical applications.