Application of pediatric ocular trauma score in pediatric open globe injuries

AIM:To evaluate the predictive value of pediatric penetrating ocular trauma score(POTS)on the visual outcome in children with open globe injury.METHODS:A retrospective study in 90 children(60 males and 30 females)aged 1-15 y(average,7.48±2.86 y)with penetrating ocular trauma was performed.Each patient’s POTS was calculated.The effects of POTS on final visual acuity(FVA)were examined.Correlation between factors affecting POTS and the FVA was established.RESULTS:All patients presented with single-eye trauma.The follow-up time was 3-21 mo(average,10.23±3.54 mo).Among the 90 cases of penetrating wounds,71 eyes(78.89%)were injured in Zone I(wound involvement limited to the cornea,including the corneoscleral limbus),17 eyes(18.89%)were injured in Zone II(wound involving the sclera and no more posterior than 5 mm from the corneoscleral limbus),and 2 eyes(2.22%)were injured in Zone III(wound involvement posterior to the anterior 5 mm of the sclera).Analysis of POTS and FVA showed important correlation between them(r=0.414,P=0.000).Initial visual acuity(P=0.00),age(P=0.02),injury location(P=0.002),traumatic cataract(P=0.00),vitreous hemorrhage(P=0.027),retinal detachment(P=0.003),and endophthalmitis(P=0.03)were found to be statistically significant factors for the FVA outcome.CONCLUSION:Ocular trauma presents serious consequences and poor prognosis in children.The POTS may be a reliable prognostic tool in children with open globe injury.

Reliability of the ocular trauma score for the predictability of traumatic and post-traumatic retinal detachment after open globe injury

AIM: To elucidate the question of whether the ocular trauma score(OTS) and the zones of injury could be used as a predictive model of traumatic and post traumatic retinal detachment(RD) in patients with open globe injury(OGI).METHODS: A retrospective observational chart analysis of OGI patients was performed. The collected variables consisted of age, date, gender, time of injury, time until repair, mechanism of injury, zone of injury, injury associated vitreous hemorrhage, trauma associated RD, post traumatic RD, aphakia at injury, periocular trauma and OTS in cases of OGI. RESULTS: Totally 102 patients with traumatic OGI with a minimum of 12 mo follow-up and a median age at of 48.6 y(range: 3-104 y) were identified. Final best corrected visual acuity(BCVA) was independent from the time of repair, yet a statistically significant difference was present between the final BCVA and the zone of injury. Severe trauma presenting with an OTS score Ⅰ(P<0.0001) or Ⅱ(P<0.0001) revealed a significantly worse BCVA at last follow up when compared to the cohort with an OTS score >Ⅲ. OGI associated RD was observed in 36/102 patients(35.3%), whereas post traumatic RD(defined as RD following 14 d after OGI) occurred in 37 patients(36.3%). OGI associated RD did not correlate with the OTS and the zone of injury(P=0.193), yet post traumatic RD correlated significantly with zone Ⅲ injuries(P=0.013). CONCLUSION: The study shows a significant association between lower OTS score and zone Ⅲ injury with lower final BCVA and a higher number of surgeries, but only zone Ⅲ could be significantly associated with a higher rate of RD.

Predictive value and applicability of ocular trauma scores and pediatric ocular trauma scores in pediatric globe injuries

AIM: To evaluate the predictive value and applicability of Ocular Trauma Score(OTS) and Pediatric Ocular Trauma Score(POTS) for closed and open globe injuries in the pediatric group.METHODS: A retrospective study of closed and open globe injuries in children age of 0-18-year-old between 2012-2019 was conducted.Medical records were collected,and injuries were classified using Birmingham Eye Trauma Terminology System(BETTS).The predictive value and applicability of both OTS and POTS to final visual acuity(VA) were analyzed.RESULTS: Of 84 patients,59(70.2%) presented with closed globe injuries(CGI) and 25(29.8%) with open globe injuries(OGI).The mean of initial VA was 0.832±0.904 log MAR.OTS and POTS was calculated.Initial VA(P<0.001) and traumatic cataract(P<0.001) were significantly associated with visual outcome,followed by organic/unclean wound (P=0.001),delay of surger y(P=0.001),iris prolapse(P=0.003),and globe rupture(P=0.008).A strong correlation between OTS and POTS and final VA(r=-0.798,P<0.001;r=-0.612,P<0.001) was found.OTS was more applicable in all age group of pediatric and in contrast to POTS,it was designed for 0-15 years old.POTS requires eleven parameters and OTS six parameters.Even though initial VA was not available,we could still calculate into POTS equation.CONCLUSION: OTS and POTS are highly predictive prognostic tools for final VA in CGI and OGI's in children.

严重多发外伤患者并发脓毒症的危险因素及风险预测模型构建

目的分析严重多发外伤患者并发脓毒症的危险因素,并建立风险预测模型。方法收集南阳市第一人民医院2021年1月至2022年12月收治的120例严重多发外伤患者临床资料进行回顾性分析,依据是否并发脓毒症分为脓毒症组41例与非脓毒症组79例。采用logistic回归分析影响严重多发外伤患者并发脓毒症的危险因素,依据回归分析结果构建风险预测模型,并计算一致性指数(C-index)判断模型区分度。结果脓毒症组年龄、中性粒细胞与淋巴细胞计数比值(NLR)、活化部分凝血活酶时间(APTT)、创伤严重程度评分(ISS)、序贯器官衰竭(SOFA)评分均大于非脓毒症组,机械通气患者占比高于非脓毒症组,差异有统计学意义(P<0.05);经logistic回归分析显示,NLR、APTT、ISS评分为严重多发外伤患者并发脓毒症的独立危险因素(OR>1,P<0.05);绘制列线图构建严重多发外伤患者并发脓毒症的风险预测模型,验证模型区分度显示C-index值=0.908,区分度良好;绘制标准曲线显示,校准曲线和Y-X直线紧密贴合,模型准确度良好。结论NLR、APTT、ISS评分为严重多发外伤患者并发脓毒症的危险因素,基于上述因素构建的风险预测模型对严重多发外伤患者并发脓毒症具有较高预测价值。

人员易损性分析研究进展及应用综述

人员是战场中的核心要素,是最易损、最复杂的对象之一,其易损性研究涉及力学、数学、统计学、医学、生物学等多学科交叉,研究难度大,但对于开展杀伤效能评估、防护效能、战伤救治等具有重要价值。通过总结不同目标易损性分析的文献,提出损伤评分及杀伤判据是人员易损性分析中的两个重要环节。回顾了人员损伤评分的研究现状,重点介绍了4种常用评分方法(简明创伤评分、损伤严重度评分、校正损伤严重度指数、军用战伤评分)及应用情况;给出了典型战场环境中冲击波、投射物、冲击振动、热4种主要杀伤元对无防护人员损伤的研究动态、评估模型、杀伤判据。分析了基于数字化人体模型开展的人员易损性分析应用技术,探讨了易损性分析结果的主要应用场景,分析了该领域可能的主要发展方向。所得结果可为人员易损性研究提供重要参考。

Characteristics and visual outcomes of patients hospitalized for ocular trauma in central China: 2006-2011

AIM: To complete the data of ocular trauma in central China, as a well-known tertiary referral center for ocular trauma, we documented the epidemiological characteristics and visual outcomes of patients hospitalized for ocular trauma in this region.METHODS: A retrospective study of patients hospitalized for ocular trauma in central China from 2006 to 2011 was performed.· RESULTS: This study included 5964 eyes of 5799 patients. The average age was 35.5 ±21.8y with a male-to-female ratio of 2.8:1. The most common age was 45-59 y age group. Most patients were farmers and workers(51.9%). The most common injuries were firework related(24.5%), road traffic related(24.2%), and work related(15.0%). Among the most common causative agents were firecrackers(24.5%), followed by metal/knife/scissors(21.4%). Most injuries occurred in January(14.2%),February(27.0%), and August(10.0%). There were 8.5%patients with ocular injuries combined with other injuries.The incidence of open ocular injuries(4585 eyes, 76.9%)was higher than closed ocular injuries(939 eyes, 15.7%).The incidences of chemical and thermal ocular injuries were 1.2% and 0.6%. Ocular trauma score(OTS)predicted final visual acuity at non light perception(NLP), 20/200-20/50 and 20/40 with a sensitivity of 100%,and light perception(LP) /hand motion(HM) and 1/200-19/200 with a specificity of 100%.· CONCLUSION: This study provides recent epidemiological data of patients hospitalized for ocular trauma in central China. Some factors influencing the visual outcome include time interval between injury and visit to the clinic, wound location, open or closed globe injury, initial visual acuity, and OTS.

Visual outcomes in patients with open globe injuries compared to predicted outcomes using the Ocular Trauma Scoring system

AIMTo determine the visual outcomes in adult patients who sustained open globe injuries and to determine whether the visual prognosis following an eye injury in an African setting differs from the predicted outcomes according to the Ocular Trauma Score (OTS) study. A secondary aim was to establish the evisceration rate for these injuries and assess how this form of intervention affected outcomes in comparison to the OTS.METHODSA prospective case series of all patients admitted with open globe injuries over a two-year (July 2009 to June 2011) period. Injuries were scored using the OTS and the surgical intervention was recorded. The best corrected visual acuity at three months was regarded as visual outcome.RESULTSThere were 249 open globe injuries, of which 169 patients (169 eyes) completed the 3-month follow-up. All patients underwent primary surgery, 175 (70.3%) repairs, 61 (24.5%) eviscerations and 13 (5.2%) other procedures. Globe eviscerations were mainly done on OTS Category 1 cases, but outcomes in this category were not found to be different from OTS outcomes. Outcomes were significantly worse in Category 2, but when the entire distribution was tested, the differences were not statistically significant. The overall association between OTS outcomes and the final visual outcomes in this study was found to be a strong (P&#x0003c;0.005).CONCLUSIONReliable information regarding the expected outcomes of eye injuries will influence management decisions and patient expectations. The OTS is a valuable tool, the use of which has been validated in many parts of the world-it may also be a valid predictor in an African setting.

以简明损伤定级标准与创伤严重程度评分为基础的分级护理在急诊创伤骨折患者中的应用效果

目的:探讨以简明损伤定级标准与创伤严重程度(AIS-ISS)评分为基础的分级护理在急诊创伤骨折患者中的应用效果,为临床护理提供依据。方法:选取2021年1月—2022年12月福建医科大学附属第一医院急诊科收治的100例创伤骨折患者作为研究对象,采用随机数表法将其分为对照组与试验组,每组各50例。对照组患者采用急诊常规护理,试验组患者在急诊常规护理基础上实施以AIS-ISS评分为基础的分级护理。比较两组患者的救治效果、护理服务质量及护理满意度情况。结果:试验组患者评估伤情时间、入院检查时间、有效救治时间、住院时间均明显短于对照组,救治成功率高于对照组,并发症发生率低于对照组,差异有统计学意义(t=13.205、7.815、10.289、10.978,χ^(2)=7.527、5.005,P<0.05)。试验组患者感知护理服务质量评价量表中各维度评分均明显高于对照组,差异有统计学意义(t=6.941、6.661、6.836、8.971,P<0.05)。试验组患者护理满意度量表中各维度评分及总分均明显高于对照组,差异有统计学意义(t=6.350、12.034、9.176、7.509、16.005,P<0.05)。结论:以AIS-ISS评分为基础对急诊创伤骨折患者实施分级护理,能够提高护理服务质量,缩短患者救治时间,提高救治成功率,改善患者临床结局,进而提升护理满意度。

脑外伤后睡眠障碍患者医患护三位一体实施的应用效果

目的:以脑外伤以后出现睡眠障碍的患者为研究对象,分析医患护三位一体的实施效果。方法:选取2023年1月至2023年12月福建省立医院南院收治的脑外伤且均伴有不同程度的睡眠障碍患者76例作为研究对象,按照系统随机化法分为对照组和观察组,每组38例。对照组采取常规护理,观察组应用医患护三位一体,对比干预效果,评估指标包含睡眠质量、心理状态、疾病不确定感。结果:护理前,2组患者睡眠质量、心理状态以及疾病不确定感评分比较,差异无统计学意义(P>0.05)。护理后,睡眠质量评分均降低,且观察组较对照组低(P<0.05);护理后,观察组HAMA、HAMD评分低于对照组(P<0.05),观察组疾病不确定感低于对照组(P<0.05)。结论:予以脑外伤后睡眠障碍患者医患护三位一体干预对于提高睡眠质量、改善心理状态具有突出效果,有利于减轻患者疾病不确定感,具有较高借鉴价值。

修正创伤评分指导下多学科团队合作创伤团队一体化急救护理在严重多发性创伤休克患者救护中的应用

目的:探究修正创伤评分(RTS)指导下多学科团队合作(MDT)创伤团队一体化急救护理在严重多发性创伤休克患者救护中的应用效果。方法:选取2017年1月—2023年6月肇庆市第一人民医院收治的严重多发性创伤休克患者80例作为研究对象,采用随机数字表法分为观察组和对照组,各40例。对照组给予常规急救护理干预,观察组给予RTS指导下MDT创伤团队一体化急救护理干预。比较两组患者急救状况、急救结局、急救护理质量评分。结果:观察组入院至确诊、入院至手术、入院至病房时间及住院时间均短于对照组,差异有统计学意义(P<0.05);观察组急救成功率高于对照组,观察组并发症总发生率低于对照组,差异有统计学意义(P<0.05);观察组护理服务、健康教育、岗位职责、信息沟通、候诊环境评分高于对照组,差异有统计学意义(P<0.001)。结论:RTS指导下MDT创伤团队一体化急救护理干预应用于严重多发性创伤休克患者中,能够快速评估患者创伤情况,缩短急救时间,改善患者急救结局,提高急救护理质量。

开放性眼外伤患者临床特征及视力影响因素分析

目的:总结西北地区开放性眼外伤住院患者的临床特征、预后视力影响因素,并探讨眼外伤评分(OTS)在开放性眼外伤中的应用。方法:回顾性分析2021-06/2023-06在西京医院收住院的91例91眼开放性眼外伤患者的临床数据资料。对年龄、就诊时间、初视力、外伤分区等因素进行视力预后的相关性分析,并探讨不同OTS评分分级与预后视力的关系。结果:单因素分析显示年龄(0-20岁)、就诊时间(<24 h)、初始视力、外伤分区、外伤类型(穿通伤)、前房积血、玻璃体积血与预后视力有关(均P<0.1);多因素Logistic回归分析显示初始视力及就诊时间(<24 h)是危险因素(均P<0.05)。不同OTS评分分级与预后视力有显著相关性(r s=0.639,P<0.001)。结论:开放性眼外伤患者应尽早及时诊治,其预后视力主要影响因素有年龄、就诊时间、初始视力、外伤分区、外伤类型、前房积血及玻璃体积血。OTS评分在开放性眼外伤预后视力评估中有良好的应用价值。

改良皮内缝合对颌面部创伤患者创口愈合效果及瘢痕评分的影响

目的 研究改良皮内缝合对颌面部创伤患者创口愈合效果及瘢痕评分的影响。方法 选取2020年1月至2023年5月我院收治的100例颌面部创伤患者为研究对象,以随机数字表法将其分为对照组和观察组,每组50例。对照组行间断缝合,观察组行改良皮内缝合。比较两组的创口愈合效果,炎症因子[C反应蛋白(CRP)、降钙素原(PCT)]水平、视觉模拟评分量表(VAS)评分、温哥华瘢痕评价量表(VSS)评分、并发症发生情况及满意度。结果 观察组的创口愈合优良率为96.00%,高于对照组的84.00%(P<0.05)。术后,两组的CRP、PCT水平均低于术前,且观察组低于对照组(P<0.05)。术后3、7、14 d,两组的VAS评分均低于术前,且观察组低于对照组(P<0.05)。术后14、21、60 d,两组的VSS评分均低于术后7 d,且观察组低于对照组(P<0.05)。观察组的并发症总发生率为2.00%,低于对照组的14.00%(P<0.05)。观察组的满意度为94.00%,高于对照组的78.00%(P<0.05)。结论 改良皮内缝合治疗颌面部创伤患者的效果显著,可促进创口愈合,减少瘢痕产生,值得推广。

基于ROC曲线的几种创伤严重程度评估工具对老年创伤患者院内死亡预测效果的对比研究

目的比较新损伤严重程度评分(NISS)、指数型损伤严重程度评分(EISS)、创伤和损伤严重程度评分(TRISS)及老年创伤结局评分(GTOS)用于预测老年创伤患者院内死亡风险的效果。方法回顾性追溯选定时间跨度(2019年1月至2022年12月)内所有经急诊入院的老年创伤患者(共197例)的临床资料,计算并统计上述4种创伤严重程度评估工具的结果并绘制受试者工作特征(ROC)曲线,分析比较各评估工具的ROC曲线下面积(AUC)、约登指数以及敏感度、特异度,并以传统的损伤严重程度评分(ISS)的结果作为对照。结果4种改进型评估工具的预测效果均优于传统评估工具(ISS评分)。其中,TRISS评分的AUC、约登指数、敏感度和特异度均最高;NISS评分的AUC和约登指数均最低;GTOS评分的AUC和敏感度与EISS评分较为接近,但约登指数和特异度均显著高于EISS评分。结论TRISS评分在急诊老年创伤患者死亡风险预测评估方面的综合应用效果最佳,GTOS评分预测效果不及TRISS,但评估计算过程更简单,其改进和优化值得进一步探索。

急诊动态面板信息化在三大中心建设中的应用效果

目的本研究旨在评估急诊动态面板信息化在胸痛中心、卒中中心和创伤中心建设中的应用效果。方法选择2021年1月1日至2022年12月31日在厦门长庚医院胸痛中心、卒中中心、创伤中心就诊的心肌梗死、脑梗死及疼痛患者500例作为研究对象,样本选择方法为随机取样。2021年1月1日至12月31日急诊采用传统非信息化系统进行运作,为对照组;2022年1月1日至2022年12月31日急诊采用动态面板信息化进行运作,为试验组。比较两个时间段中患者预检分诊的评估、急诊关键环节的时效、抢救成效及不良事件。结果试验组的漏诊率、误诊率和不良事件总发生率低于对照组,预检分诊准确率、抢救成功率高于对照组,差异有统计学意义(P<0.05);试验组的专科介入时间、检验获取时间、检查获取时间、滞留时间短于对照组,差异有统计学意义(P<0.05)。结论急诊动态面板信息化在胸痛中心、卒中中心和创伤中心的建设中具有显著的应用效果。

急诊CRAMS评分结合分级转运护理在多发性创伤患者中的应用

目的研究分析急诊循环、呼吸、腹部、运动、语言(CRAMS)评分结合分级转运护理在多发性创伤患者中的应用效果。方法选取2022年7月至2023年7月福建医科大学附属第一医院急诊接受治疗的多发性创伤患者100例作为研究对象,依据抛硬币法对患者进行分组,分为对照组与观察组,各50例。对照组实施常规急诊护理,观察组给予急诊CRAMS评分结合分级转运护理。对两组伤情评估正确率、急救成功率、急救时效、心理状态、不良事件发生率、护理满意度进行分析比较。结果相较于参照组,观察组伤情评估正确率、急救成功率更高(P<0.05)。与对照组比较,观察组就诊等待时间、急救检查时间、急诊停留时间更短(P<0.05)。相较于护理前,两组护理后心理状态各指标评分明显降低(P<0.05);在护理后,观察组心理状态各指标评分明显低于对照组(P<0.05)。相比于对照组,观察组不良事件发生率更低,护理满意度更高(P<0.05)。结论急诊CRAMS评分结合分级转运护理有助于正确评估多发性创伤患者的伤情,可明显提高急救时效与急救成功率,改善心理状态,减少不良事件的发生,加快患者病情康复。

RDW联合TTS评分对肺挫伤致ARDS的预测价值研究

目的探讨红细胞分布宽度(RDW)联合胸部创伤严重性(TTS)评分对肺挫伤致急性呼吸窘迫综合征(ARDS)的预测价值。方法选择2022年2月—2023年2月于本院重症医学科符合纳入标准患者的临床资料,包括患者的一般资料、白细胞计数(WBC)、RDW、C反应蛋白、血气分析、氧合指数、肝肾功能、胸部CT、创伤原因、既往病史、并发症、TTS评分。根据柏林标准分为ARDS组和非ARDS组,分析两组的一般临床资料,绘制RDW、TTS评分及RDW联合TTS评分的ROC曲线。结果符合纳入标准的患者有56例,其中男性39例,女性17例。发生ARDS的有25例,31例未发生ARDS。其中发生机制为车祸伤42例,堕落伤5例,爆裂伤4例,重物砸伤2例,其他原因外伤3例。两组发生肺挫伤的患者中男性均多于女性,肺挫伤中创伤原因为车祸的人数最多。TTS评分、RDW、WBC、氧合指数(PaO2/FiO2)比较差异有统计学意义(P<0.05),RDW与WBC、TTS、RDW/ALB呈正相关(r=0.186,P=0.05;r=0.648,P=0.001;r=0.812,P=0.003),与PaO2/FiO2呈负相关(r=-0.013,P=0.006)。RDW、TTS、RDW联合TTS评分的曲线下面积(AUC)分别为0.811、0.966、0.976,RDW联合TTS评分的AUC高于RDW及TTS评分单独预测。结论RDW、TTS、RDW联合TTS评分对肺挫伤致ARDS均有较好的预测效能,但RDW联合TTS评分评估肺挫伤致ARDS发生的特异性及敏感性优于单个临床指标。

RDW联合TTS评分对肺挫伤致ARDS的预测价值

目的探讨红细胞分布宽度(RDW)联合胸部创伤严重(TTS)评分对肺挫伤致急性呼吸窘迫综合征(ARDS)的预测价值。方法收集2022年2月—2023年2月徐州仁慈医院重症医学科符合纳入标准患者的临床资料,包括患者的性别、年龄、身高、体重、白细胞计数、RDW、C反应蛋白、动脉血气、氧合指数、肝功能、肾功能、胸部CT、创伤原因、既往病史、并发症、TTS评分。根据柏林标准分为ARDS组和非ARDS组,分析两组的一般临床资料,绘制RDW、TTS评分及RDW联合TTS评分的ROC曲线。结果本研究中符合纳入标准的患者有56例,其中男性42人,女性14人。发生ARDS的有25人,31人未发生ARDS。其中发生机制为车祸伤37人,堕落伤9人,爆裂伤4人,重物砸伤2人,其他原因外伤4人。两组发生肺挫伤的患者中男性均多于女性,肺挫伤中创伤原因为车祸的人数最多。TTS评分、RDW、WBC、PaO_(2)/FiO_(2)差异具有统计学意义(P<0.05),WBC、TTS、RDW/ALB呈正相关性(r=0.186,P=0.05;r=0.648,P=0.001;r=0.812,P=0.003),与PaO_(2)/FiO_(2)呈负相关性(r=-0.013,P=0.006)。RDW、TTS、RDW联合TTS评分的AUC为0.811、0.966、0.976,RDW联合TTS评分的AUC为0.976,高于RDW及TTS评分。结论RDW、TTS、RDW联合TTS评分对ARDS都有较强的预测价值,RDW联合TTS评分评估肺挫伤后ARDS发生的特异性及敏感性优于单个的临床指标。

血栓弹力图最大振幅评价重症创伤患者预后及其影响因素的分析

目的研究血栓弹力图(TEG)最大振幅(MA)评价重症创伤患者预后的作用及其影响因素。方法回顾性分析2020年07月到2023年07月我院急诊科和ICU收治的损伤严重度评分(ISS)评分≥16的重度创伤患者112例。根据TEG的MA值将患者分为MA≥50 mm组(71例)和MA<50 mm组(41例),并对两组患者的凝血酶⁃抗凝血酶复合物(TAT)、组织纤溶酶原激活物⁃纤溶酶原激活物抑制剂⁃1复合物(t⁃PAIC)、纤溶酶⁃α2纤溶酶抑制物复合物(PIC)、纤维蛋白原(FIB)、血小板(PLT)计数和ISS评分指标进行统计分析。结果与MA≥50 mm组相比,MA<50 mm组患者TAT、PIC、t⁃PAIC和ISS评分均明显升高(P<0.05或P<0.01);FIB和PLT计数明显降低(P<0.01)。相关性分析结果显示,MA与tPAIC、TAT、PLT计数和ISS评分等指标相关(P<0.05),且与PIC和FIB相关度较高(0.4<r<0.7,P<0.05)。MA≥50 mm组重症创伤患者的28 d死亡率(26.73%)明显低于PLT计数≥100×10^(9)/L组(44.44%)(P<0.05);MA<50 mm组重症创伤患者的28 d死亡率(75.61%)明显高于PLT计数<100×10^(9)/L组(45.00%)(P<0.01)。ROC曲线显示MA预测重症创伤患者存活率的曲线下面积(AUC)为0.776,明显高于PLT计数预测重症创伤患者存活率的AUC(0.563)(P<0.01)。结论TEG的MA能有效评价重症创伤患者的预后,且与创伤严重程度有关。

营养控制状况评分与创伤患者发生感染性并发症相关性研究

目的 探讨营养控制状况(CONUT)评分与创伤患者发生感染性并发症的相关性。方法 回顾性分析自2021年12月至2022年12月东部战区总医院重症监护室(ICU)收治的141例创伤患者临床资料,按是否发生感染性并发症分为A组(未发生感染性并发症,n=82)与B组(发生感染性并发症,n=59)。收集可能导致患者发生感染性并发症的相关因素,包括基本资料、治疗措施及实验室检查指标等。采用Logistic回归分析发生感染性并发症的危险因素,采用Spearman相关性分析对CONUT评分与营养风险筛查2002(NRS 2002)、血清白蛋白(ALB)的相关性进行分析。采用受试者工作特征(ROC)曲线评价CONUT评分对创伤患者发生感染性并发症的预测价值,并用DeLong非参数检验对比各指标预测感染性并发症发生的ROC曲线下面积(AUC)。结果 Spearman相关性分析结果显示,CONUT评分与NRS 2002呈正相关性(r=0.921,P<0.001);CONUT评分与ALB呈负相关(r=-0.827,P<0.001)。多因素Logistic回归分析结果显示,机械通气时间、损伤严重度评分(ISS)、CONUT评分、手术时长、ICU住院时间是创伤患者发生感染性并发症的独立危险因素(P<0.05)。ROC曲线结果显示,CONUT评分、NRS 2002、ALB预测创伤患者发生感染性并发症的AUC分别为0.796(95%可信区间:0.722~0.869)、0.748(95%可信区间:0.672~0.824)、0.732(95%可信区间:0.646~0.818),Youden指数最大值为0.511、0.478、0.431,截断值分别为5分、3分、35.4 g/L。DeLong非参数检验结果显示,CONUT评分预测创伤患者发生感染性并发症的AUC高于NRS 2002(Z=2.072)、ALB(Z=2.198),差异有统计学意义(P<0.05)。结论 机械通气时间、ISS、CONUT评分、手术时长、ICU住院时间是创伤患者发生感染性并发症的独立危险因素。CONUT评分较NRS 2002和ALB预测感染性并发症的效果更好,当CONUT评分≥5分时,创伤患者的营养状况更差,感染性并发症发生风险升高。

Predictors of visual outcome in traumatic cataract

Traumatic cataract resulting from open- or closed-globe ocular trauma is one of the most common causes of blindness. Visual outcome is unpredictable because this is not determined solely by the lens. There is a lack of a standard classification, investigations, and treatment guidelines related to the outcome, with considerable debate regarding predictive models. We review the predictors of visual outcome following surgical treatment of traumatic cataracts, which may act as a guide to clinicians.