血乳酸、随机血糖联合RTS评分系统在创伤失血性休克中的预测价值

Predictive value of serum lactate and random blood glucose combined with RTS in traumatic hemorrhagic shock

目的观察在创伤失血性休克患者中血乳酸、随机血糖联合RTS评分对患者预后结局的预测价值。方法本研究纳入自2017年7月至2019年6月在解放军总医院第四医学中心急诊监护室住院的创伤失血性休克患者。按预后不同分为存活组和死亡组。按不同时间点,即:患者入院当时和入院后12 h、24 h、48 h,分别检测患者的随机血糖、血清乳酸水平,并根据RTS评分系统对患者进行评分。对上述数据进行二元Logistic回归分析,并绘制ROC曲线。每例患者随访3个月(发生死亡的,随访至死亡时终止)。结果本研究纳入患者68名,存活53名,死亡15名。经回顾性、多因素回归分析发现,随机血糖、血乳酸及RTS评分与创伤失血性休克患者结局相关。通过比较ROC曲线下面积,发现24 h随机血糖、12 h血乳酸、12 h RTS评分的AUC分别为:0.907,95%可信区间(95%CI)为0.818~0.995;0.930,95%CI为0.862~0.999;0.739,95%CI为0.586~0.892。而三者综合的AUC为0.994,95%可信区间(95%CI)为0.981~1.000。结论血乳酸、随机血糖联合RTS评分对于预测创伤失血性休克患者的预后具有显著的临床意义。

Objective To evaluate the serum lactate and random blood glucose combined with revised trauma score(RTS)for predicting the mortality risk in patients with traumatic hemorrhagic shock.Methods A retrospective observational study was conducted.The adult patients with traumatic hemorrhagic shock admitted to Emergency Intensive Care Unit(EICU)of the Fourth Medical Centre of Chinese PLA General Hospital from July 1,2017 to June 1,2019 were enrolled.The patients were divided into two groups according to the outcome.The serum lactate,random blood glucose and RTS were collected at 0,12,24 and 48 h after EICU admission.The above data were analyzed by independent-sample t test,multivariate analysis of variance and binary Logistic regression.The receiver operating characteristic curve(ROC)was plotted with statistically significant parameters to assess the predictive value of the outcome in patients with traumatic hemorrhagic shock.Results A total of 68 patients with traumatic hemorrhagic shock were enrolled,in which 53 patients survived and 15 patients were dead.The serum lactate,random blood glucose and RTS were associated with the outcome.ROC curve analysis showed that the area under ROC curve(AUC)of the three indicators were 0.907(95%CI,0.818-0.995),0.930(95%CI,0.862-0.999)and 0.739(95%CI,0.586-0.892),respectively.The combined AUC was 0.994(95%CI,0.981-1.000).Conclusions The serum lactate and random blood glucose combined with RTS can be a predictive tool of outcome in patients with traumatic hemorrhagic shock.