TCC清单与qSOFA评分对严重创伤合并脓毒症的早期诊治价值

Value of TCC and qSOFA score on the early diagnosis of severe trauma with sepsis

目的探讨创伤治疗核对清单(trauma-care check list,TCC)与快速序贯器官功能评分(quick sequential organ failure assessment,qSOFA)对严重创伤合并脓毒症的早期诊治价值。方法回顾泰州市人民医院2017年2月至2018年1月间,通过院前120转运,执行不同院内救治流程收治的严重创伤患者共120例,随机(随机数字法)分组其中一组采用TCC清单、qSOFA评分,进行创伤诊治流程优化(流程优化组)共60例;采用专科会诊、全身炎性反应综合征(systemic inflammatory response syndrome,SIRS)评分,进行创伤救治流程(标准流程组)60例,以2016国际脓毒症指南标准作为脓毒症诊断依据,计算两组严重创伤合并脓毒症诊断灵敏度及特异度。分析两组确诊患者救治时间节点,比较术后第1、3、7天血乳酸水平,术后失血量,并发症发生率,术后生存率,总住院时间。结果流程优化组确诊严重创伤合并脓毒症32例,初诊41例患者中阳性27例,诊断灵敏度为84.38%,特异度为50.00%;标准流程组确诊严重创伤合并脓毒症30例,初诊38例患者中阳性25例,诊断灵敏度为83.33%,特异度为56.67%。流程优化组较标准流程组MDT会诊时间、初诊脓毒症时间、受伤到接受手术时间、总住院时间明显缩短,差异具有统计学意义(P<0.05);术后第1、3、7天血乳酸水平明显降低,差异有统计学意义(P<0.05);术后并发症发生率,28 d病死率明显降低,但差异无统计学意义(P>0.05)。结论将TCC和qSOFA用于严重创伤救治,可以优化抢救流程,明显缩短救治时间,降低术后并发症发生,快速序贯器官功能评分与全身炎性反应综合征评分用于严重创伤患者脓毒症早期筛查诊断无差异,值得推荐。

Objective To explore the value of trauma-care check list(TCC)and quick sequential organ failure assessment(qSOFA)on the early diagnosis of severe trauma with sepsis,and analyze the treatment time lines.MethodsTotally 120 patients with severe trauma treated in Taizhou People's Hospital from February 2017 to January 2018 were reviewed.Sixty cases adopted TCC and qSOFA trauma care integration process(integration group),and the rest 60 cases adopted systemic inflammatory response syndrome(SIRS)score and emergency surgery multi-section support process(traditional group).According to the 2016 International Sepsis Guide Criteria,the diagnostic sensitivity and specific degrees of the two groups were calculated.The treatment time node,blood loss,complication rate,postoperative survival rate,and the total length of hospital stay of the two groups were analyzed.ResultsOf the 60 cases in the integration group,32 cases were confirmed severe trauma with sepsis,and 27 cases were confirmed in 41 primary diagnosed patients,with a diagnostic sensitivity of 84.38%and a specific degree of 50.00%.In the traditional group,30 cases were confirmed severe trauma with sepsis,and 25 cases were confirmed in 38 primary diagnosed patients with a diagnostic sensitivity of 83.33%and a specific degree of 56.67%.The significant shorter MDT consultation time,primary diagnosis time of sepsis,the duration from injury to surgery time and total hospitalization time were statistically significant different between the two groups(P<0.05).Patients in the integration group had significantly lower incidence of postoperative complications and 28-day fatality rate,but there was no significant difference between them(P>0.05).ConclusionsTCC and qSOFA score in the treatment of severe trauma can optimize salvage process,significantly shorten the treatment time,and reduce postoperative complications.Moreover,qSOFA score and SIRS score have the same effect on the early diagnosis of sepsis in patients with severe trauma.