创伤严重度评分和凝血功能指标在急诊外科患者病情及预后判断中的临床意义

Clinical significance of injury severity score and coagulation function index in judging the condition and prognosis of emergency surgical patients

目的探讨创伤严重度评分(ISS)和凝血功能指标在急诊外科患者病情及预后判断中的临床意义。方法选取2020年3月至2022年4月抚州市第一人民医院急诊科收治的60例创伤患者作为研究对象,按照ISS分为非危重症组(ISS≤16分,n=11)、危重症组(ISS 17~25分,n=28)、极危重症组(ISS>25分,n=21),均采取综合治疗方法治疗。比较3组凝血功能指标[D-二聚体(D-D)、纤维蛋白原(FIB)、部分活化凝血酶原时间(APTT)、凝血酶原时间(PT)、血小板计数(PLT)];根据患者入院28 d后的预后结局分为死亡组(n=12)与生存组(n=48),比较两组ISS及凝血功能指标水平;分析ISS、凝血功能指标及两者联合对预后预测的灵敏度、特异度。结果生存组PLT、FIB水平均高于死亡组,D-D水平及ISS均低于死亡组,PT、APTT均短于死亡组,差异有统计学意义(P<0.05)。非危重症组PLT、FIB水平均高于极危重症组,且FIB水平高于危重症组,差异有统计学意义(P<0.05);非危重症组D-D水平低于危重症组、极危重症组,且危重症组低于极危重症组,差异有统计学意义(P<0.05);非危重症组PT、APTT均短于危重症组、极危重症组,且危重症组短于极危重症组,差异有统计学意义(P<0.05)。ISS联合凝血指标预测患者预后的灵敏度、特异度均高于ISS、凝血指标单独检测,差异有统计学意义(P<0.05)。结论评估ISS、检测凝血功能指标有助于了解急诊外科患者病情,并对其预后进行准确判断,两者联合可明显提高预后预测价值。

Objective To explore the clinical significance of injury severity score(ISS)and coagulation function index in judging the condition and prognosis of emergency surgical patients.Methods A total of 60 trauma patients admitted to department of Emergency,Fuzhou First People's Hospital were selected as the study subjects,the they were divided into the non-critical group(ISS≤16 scores,n=11),critical group(ISS 17-25 scores,n=28),and the extremely critical group(ISS>25 scores,n=21)according to ISS,and all were treated with comprehensive treatment.ISS score and coagulation function index(D-dimer[D-D],fibrinogen concentration[FIB],activeated partial thromboplasting time[APTT],prothrombin time[PT]and platelet count[PLT])were compared among the three groups.The patients were divided into the death group(n=12)and the survival group(n=48)according to their prognosis 28 d after admission,ISS score and coagulation function index levels were compared between the two groups.The sensitivity and specificity of ISS score,coagulation index and the combination of ISS score and coagulation index for prognosis prediction.Results The PLT and FIB levels in the survival group were higher than those in the death group,and the D-D levels and ISS scores were lower than those in the death group,PT and APTT were shorter than those in the death group,the differences were statistically significant(P<0.05).The levels of PLT and FIB in non-critical group were higher than those in the extremely critical group,and the FIB levels were higher than the critical group,the differences were statistically significant(P<0.05);the D-D level in the non-critical group was lower than that in the critical group and the extremely critical group,and the critical group was lower than that in the extremely critical group,the differences were statistically significant(P<0.05).The PT and APTT in the non-critical group were shorter than those in the critical group and the extremely critical group,and the critical group was shorter than the extremely critical group,the differences were statistically significant(P<0.05).The sensitivity and specificity of ISS combined with coagulation index in predicting the prognosis of patients were higher than that of ISS and coagulation index alone,and the difference was statistically significant(P<0.05).Conclusion Through the evaluation of ISS score and the detection of coagulation function indicators,which can help us to understand the condition of emergency surgical patients and accurately judge their prognosis,the combination of the two can significantly improve the predictive value.