创伤严重度CRAMS评分对多发伤患者心脏损伤的评估价值

Clinical value of CRAMS scores in evaluation of severity of blunt cardiac injury in multiple trauma patients

目的 观察多发伤患者创伤严重度循环、呼吸、腹部、运动及言语（circulation,respiration,abdomen,motor,speech,CRAMS）评分对心脏损伤判定的临床价值.方法 选择多发伤患者232例,均在入院时作CRAMS评分,总分≥9分为轻伤,7～8分为重伤,≤6分为极重伤.在入院当时行心电图检查,在入院当时,伤后12h、24h、3d、7d行血清cTnl测定,并在伤后3d行超声心动图和X线胸片检查.根据测得结果结合临床表现作钝性心脏损伤（blunt cardiac injury,BCI）Basil M.RuDusky的分级观察.分析CRAMS评分与BCI BasilM.RuDusky分级的相关性.结果 232例患者中CRAMS≥9分（轻伤组）81例（34.91％）,7～8分（重伤组）92例（39.66％）,≤6分（极重伤组）59例（25.43％）,符合BCI分级Ⅰ～Ⅳ级者204例（87.93％）.232例CRAMS评分与Basil M.RuDusky分级具有良好的负相关性（rs=-0.824,P＜0.05）.结论 简便易行的CRAMS评分可在多发伤救治中取代繁琐的Basil M.RuDusky标准分级,对患者进行心脏损伤及其严重程度的评估.CRAMS评分越低的患者,存在钝性心脏损伤或其伤情越重的可能性越大.

Objective To investigate the clinical value of CRAMS （circulation, respiration,abdomen,motor,speech） scores for evaluation of severity of blunt cardiac injury （BCI） in patients with multiple trauma. Methods Total 232 patients with multiple trauma were classified as minor injury （CRAMS≥9）, severe injury （CRAMS 7 - 8） and extremely severe injury （CRAMS≤6） according to the CRAMS scores at admission. ECG examination was performed at admission and serum cTnl lev- els were measured at admission,12h, 24h, 3d and 7d after admission. Ultrasonic echocardiography and X-ray examination were performed at d3 after injury. The blunt cardiac injury was graded with RuDusky method and the correlation of CRAMS scores with RuDusky BCI grades was analyzed. Results In 232 patients,81 were classified as minor injury （34.91%）, 92 as severe injury （39.66%） and 59 as extremely severe injury （25.43%）. The CRAMS scores were negatively correlated with BCI grades （rs=-0.824, P〈0.05）. Conclusion The CRAMS scores can be used to evaluate the severity of BCI. Patients with lower CRAMS scores are more likely to have BCI or more severe injury.