休克指数对创伤性骨盆骨折患者病情评估及预后价值研究

The value of shock index in the prognosis of patients with traumatic pelvic fracture

目的探讨休克指数(SI)对创伤性骨盆骨折患者病情评估及预后价值研究。方法选取自2015年6月至2019年12月收治的286例创伤性骨盆骨折患者为研究对象。根据院内存活情况,将患者分为存活组(n=245)和死亡组(n=41)。建立Logistic多因素回归模型分析影响创伤性骨盆骨折患者院内死亡的因素;绘制ROC曲线分析SI预测输血和死亡预后的价值,计算灵敏度和特异度。结果年龄、哥斯拉昏迷评分为(GCS)、改良创伤评分(RTS)、输血、SI是创伤性骨盆骨折患者院内死亡的独立影响因素。SI预测创伤性骨盆骨折患者院内死亡的受试者工作特征曲线(ROC)曲线下面积为0.782(95%可信区间0.721~0.823),临界值为0.93时,灵敏度和特异度为78.25%和73.21%。SI≥0.7的患者输血比例明显高于SI<0.7的患者,差异有统计学意义(P<0.05)。SI预测输血的ROC曲线下面积为0.728(95%可信区间0.701~0.799),临界值为0.87时,灵敏度和特异度为90.25%和83.54%。结论年龄、GCS评分、RTS评分、输血及SI是创伤性骨盆骨折患者院内死亡的独立影响因素。SI可反映即时血流动力学稳定性情况,是一种无创、简便、重复性强的指标,有助于对急诊患者进行病情评估。SI对预测患者是否接受输血和院内死亡有一定价值。

Objective To investigate the prognostic value of shock index(SI)in patients with traumatic pelvic fractures.Methods A retrospective study was performed on 286 cases of patients with traumatic pelvic fracture who were admitted from June 2015 to December 2019.According to the in-hospital survival,the patients were divided into the survival group(n=245)and the death group(n=41).Logistic multivariate regression model was established to analyze the factors affecting the nosocomial death of patients with traumatic pelvic fractures.ROC curve was drawn to analyze the value,computational sensitivity and specificity of SI in predicting blood transfusion and death prognosis.Results Age,godzilla coma score(GCS),revised trauma score(RTS),blood transfusion and SI were independent risk factors for nosocomial death in patients with traumatic pelvic fractures.The area under the operating characteristic curve(ROC)was 0.782(95%CI:0.721~0.823),and the sensitivity and specificity were 78.25%and 73.21%when the critical value was 0.93.The proportion of transfusions in patients with SI≥0.7 was significantly higher than that in patients with SI<0.7,and the difference was statistically significant(P<0.05).The area under the ROC curve predicted by SI was 0.728(95%CI:0.701~0.799),and the sensitivity and specificity were 90.25%and 83.54%when the critical value was 0.87.Conclusion Age,GCS score,RTS score,blood transfusion and SI were independent risk factors for nosocomial death in patients with traumatic pelvic fractures.SI can reflect the real-time hemodynamic stability,and is a non-invasive,simple and repeatable indicator,which is helpful for the assessment of emergency patients.SI has some value in predicting whether patients will receive blood transfusions and die in hospital.