构建多发伤合并颅脑损伤患者的预后评判模型

Construction of prognostic evaluation model of patients with multiple trauma combined with craniocerebral injury

目的整合各项损伤评分,构建多发伤合并颅脑损伤患者的预后生存模型,并验证其应用性。方法连续性纳入解放军105医院于2014年10月—2017年1月接诊的多发伤合并颅脑损伤患者为研究队列,收集相关临床资料,完成各项伤情评分,并观察伤后28日内的预后转归。依据各项临床评分及预后情况,对其进行危重度评判,并判定对该类患者预后生存的影响。结果本次研究最终纳入156例多发伤合并颅脑损伤的患者其中9人失访、24例患者于伤后28日内死亡。(1)Cox回归分析显示:GCS评分、APACHE-Ⅱ量表、R-CRMAS量表、TRISS量表为多发伤合并颅脑损伤患者伤后28日内死亡的独立影响因素,其中APACHE-Ⅱ量表为危险性因素、其余量表为保护性因素;(2)ROC曲线显示:APACHE-Ⅱ≥40.81、TRISS<0.26为本研究受试者不良预后转归的评判临界值,具有显著的评判效能。结论及时完善多发伤合并颅脑损伤患者的GCS评分、APACHE-Ⅱ量表、R-CRMAS量表、TRISS量表对于评判预后具有重要临床价值,且APACHE-Ⅱ≥40.81、TRISS<0.26为衡量本病患者预后转归的临界点。

[Objective]To integrate the damage scores,construct the prognostic survival model of patients with multiple trauma combined with craniocerebral injury,and verify their applicability.[Methods]The patients with multiple trauma combined with craniocerebral injury received by the 105 th Hospital of PLA from October 2014 to January 2017 were selected as the study cohort,the relevant clinical data were collected,the injury scores were completed,and the prognosis of injury after 28 days was observed. According to the clinical scores and prognosis,the severity degree and influence of prognosis survival of patients were evaluated.[Results]A total of 156 patients with multiple trauma combined with craniocerebral injury were involved in the study,9 patients were lost,and 24 patients died within 28 days after injury.（1） Cox regression analysis showed that the GCS score,APACHE-Ⅱscale,R-CRMAS scale and TRISS scale were the independent influencing factors of death within 28 days after injury among patients with multiple trauma combined with craniocerebral injury. The APACHE-Ⅱ scale was risk factor,and the other scales were the protective factors;（2） ROC curve showed that APACHE-Ⅱ ≥40.81 and TRISS 0.26 were the critical value of poor prognosis evaluation, which had significant evaluation effectiveness.[Conclusion] The improvement of GCS score,APACHE-Ⅱ scale,R-CRMAS scale and TRISS scale of patients with multiple trauma combined with craniocerebral injury has important clinical value in evaluating prognosis. APACHE-Ⅱ ≥40.81 and TRISS 0.26 are the critical point for evaluating the prognosis and outcome of patients with multiple trauma combined with craniocerebral injury.