全身增强计算机断层扫描在严重创伤救治中的价值

The clinical value of enhanced whole-body CT in the early treatment of severe trauma

目的探讨全身增强计算机断层扫描(enhanced whole-body computed tomography,EWBCT)和非全身增强计算机断层扫描(non-Enhanced whole-body computed tomography,N-EWBCT)对严重创伤患者的漏诊率、肾功能及预后的影响。方法从苏州大学附属第二医院创伤中心的创伤数据库收集了2017年01月01日至2020年12月31日期间收治的创伤患者的临床数据。将所有纳入本研究的患者根据其是否行全身增强计算机断层扫描检查分为EWBCT组和N-EWBCT组,比较两组患者的基线资料、漏诊率、肾功能及预后等指标的差异。结果共计459例患者纳入本研究,其中EWBCT组184例,N-EWBCT组275例,结果发现:N-EWBCT组患者的漏诊率明显高于EWBCT组(18%vs.5%,P值<0.01);EWBCT组和N-EWBCT组患者发生急性肾损伤(acute kidney injury,AKI)的风险比例分别为9%vs.7%,组间比较差异无统计学意义(P值>0.05);N-EWBCT组患者的死亡发生率高于EWBCT组(23%vs.12%,P=0.002)。结论与非全身增强计算机断层扫描比较,严重创伤早期行全身增强计算机断层扫描检查不会明显增加患者肾功能损伤的风险。对于严重创伤患者,早期行全身增强计算机断层扫描可以降低其诊断漏诊率和改善临床预后。

Objective To investigate the significant effects of enhanced whole-body computed tomography(EWBCT)and non-enhanced whole-body computed tomography(N-EWBCT)on the missed diagnosis rate,renal function and prognosis of patients with severe trauma.Methods Clinical data of trauma patients admitted from January 1,2017 to December 31,2020 were collected from the trauma database of the Trauma Center of the Second Affiliated Hospital of Soochow University.All patients included in this study were divided into the EWBCT group and N-EWBCT group according to whether they underwent enhanced whole-body computed tomography examination.The differences in baseline data,missed diagnosis rate,renal function and prognosis of the two groups of patients were compared.Results A total of 459 patients were included in this study,including 184 patients in the EWBCT group and 275 patients in the N-EWBCT group.The missed diagnosis rate of the N-EWBCT group was significantly higher than that of the EWBCT group(18%vs.5%,P<0.01).The risk ratio of acute kidney injury(AKI)in the EWBCT group and N-EWBCT group was 9%and 7%,respectively,and there was no statistical difference between the two groups(P>0.05).The mortality rate of patients in the N-EWBCT group was higher than that in the EWBCT group(23%vs.12%,P=0.002).Conclusions Compared with N-EWBCT,EWBCT does not significantly increase the risk of renal damage in patients with severe trauma.For patients with severe trauma,early EWBCT can reduce the missed diagnosis rate and improve the clinical prognosis.