Traumatic brain injury and variants of shock index

Traumatic Brain Injury is a major cause of death and long-term disability.The early identification of patients at high risk of mortality is important for both management and prognosis.Although many modified scoring systems have been developed for improving the prediction accuracy in patients with trauma,few studies have focused on prediction accuracy and application in patients with traumatic brain injury.The shock index(SI)which was first introduced in the 1960s has shown to strongly correlate degree of circulatory shock with increasing SI.In this editorial we comment on a publication by Carteri et al wherein they perform a retrospective analysis studying the predictive potential of SI and its variants in populations with severe traumatic brain injury.

Treatment Analysis of Limb Fractures Combined with Traumatic Shock

Objective:To evaluate the treatment regimen and efficacy for limb fractures combined with traumatic shock(TS).Methods:A total of 88 patients with limb fractures combined with TS,admitted between January 2021 and December 2023,were selected.Patients were divided randomly using a numerical grouping method.The observation group underwent restricted fluid resuscitation combined with comprehensive treatment,while the reference group received conventional fluid resuscitation combined with comprehensive treatment.Recovery time,fracture prognosis,complications,severity of the condition,and post-fracture joint function were compared between the two groups.Results:The observation group showed shorter symptom recovery times,a higher rate of anatomical fracture reduction,and a lower complication rate compared to the reference group(P<0.05).After one week of treatment,the severity score of the condition in the observation group was lower than that of the reference group,and all joint function scores were higher in the observation group(P<0.05).Conclusion:Restricted fluid resuscitation combined with comprehensive treatment for limb fractures with TS can alleviate symptoms,improve fracture prognosis,reduce related complications,decrease the severity of trauma,and enhance joint function.The therapeutic effect is excellent.

Analysis of the Emergency Rescue Nursing Intervention Effect and Rescue Success Rate for Patients with Traumatic Hemorrhagic Shock

Objective:To analyze the value of emergency rescue nursing intervention in the care of patients with traumatic hemorrhagic shock and its impact on the success rate of rescue efforts.Methods:A total of 80 patients with traumatic hemorrhagic shock were selected as samples,with the timeframe from July 2022 to July 2023.The patients were randomly divided into two groups using a random number table method.Group A received emergency rescue nursing,while Group B received routine nursing care.The success rate of rescue,rescue indicators,complication rates,and family satisfaction with nursing care were compared between the two groups.Results:The rescue success rate in Group A was higher than in Group B(P<0.05);the total blood loss in Group A was less,and the rescue time,full transportation time,and hospitalization time were shorter than in Group B(P<0.05);the complication rate of patients with traumatic hemorrhagic shock in Group A was lower than in Group B(P<0.05);the family satisfaction with emergency nursing care in Group A was higher than in Group B(P<0.05).Conclusion:Emergency rescue interventions for patients with traumatic hemorrhagic shock can reduce blood loss,shorten rescue times,and improve the success rate of shock rescue,providing a safe and effective approach.

Clinical Effects of Intensive Insulin Therapy Treating Traumatic Shock Combined with Multiple Organ Dysfunction Syndrome

The therapeutic effects of intensive insulin therapy in treatment of traumatic shock combined with multiple organ dysfunction syndrome （MODS） were investigated. A total of 114 patients with traumatic shock combined with MODS were randomly divided into two groups： control group （n=56） treated with conventional therapy, and intensive insulin therapy group （n=58） treated with conventional therapy plus continuous insulin pumping to control the blood glucose level at range of 4.4-6.1 mmol/L. White blood cells （WBC） counts, prothrombin time （PT）, serum creatinine （SCr）, alanine aminotransferase （ALT）, serum albumin and PaO2 were measured before and at the day 1, 3, 5, 7 and 14 after treatment. The incidence of gastrointestinal dysfunction, the incidence of MODS, hospital stay and the mortality were also observed and compared. After intensive insulin therapy, the WBC counts, SCr, ALT and PT were significantly reduced （P0.05）, but the level of serum albumin was significantly increased （P0.05） at the day 3, 5, 7 and 14. In the meantime, the PaO2 was significantly elevated at the day 3, 5 and 7 （P0.01） after intensive insulin therapy. The incidence of gastrointestinal dysfunction, the incidence of MODS, the length of hospital stay and the mortality were markedly decreased （P0.01）. The results suggest early treatment with intensive insulin therapy is effective for traumatic shock combined with MODS and can decrease the length of hospital stay and the mortality.

Albumin resuscitation protects against traumatic/hemorrhagic shock-induced lung apoptosis in rats

Objective: To determine the effects of albumin administration on lung injury and apoptosis in traumatic/hemorrhagic shock (T/HS) rats. Methods: Studies were performed on an in vivo model of spontaneously breathing rats with induced T/HS; the rats were subjected to femur fracture, ischemia for 30 min, and reperfusion for 20 min with Ringer's lactate solution (RS) or 5% (w/v) albumin (ALB), and the left lower lobes of the lungs were resected. Results: Albumin administered during reperfusion markedly attenuated injury of the lung and decreased the concentration of lactic acid and the number of in situ TdT-mediated dUTP nick-end labelling (TUNEL)-positive cells. Moreover, immunohistochemistry performed 24 h after reperfusion revealed increases in the level of nuclear factor κB (NF-κB), and phosphorylated p38 mitogen-activated protein kinase (MAPK) in the albumin-untreated group was down-regulated by albumin treatment when compared with the sham rats. Conclusion: Resuscitation with albumin attenuates tissue injury and inhibits T/HS-induced apoptosis in the lung via the p38 MAPK signal transduction pathway that functions to stimulate the activation of NF-κB.

Effect of preoperative limited fluid resuscitation to the patients with traumatic shock

Objective： To investigate the effect of preoperative limited fluid resuscitation on the patients with traumatic shock. Methods： Eighty-nine patients with multiple injuries complicating with shock were treated in Changhai Hospital Between January 2002 to October 2005 and were divided into 3 groups according to the preoperative levels of systolic blood pressure （SBP）. SBP of group A and group B were about 70 and 80 mmHg, respectively; and the SBP of group C was over 90 mmHg. Results, （1） There was no significant difference in age, gender, and injury severity score （ISS）, initiated resuscitation time and initiated operation time among the 3 groups. Preoperatively, there was significant difference in the amount of fluid resuscitation and infused erythrocyte suspension among group A, B and C （1687 ± 96 ml, 2096 ± 87 ml, 2976±93 ml, P〈0. 05; and 294±110 ml, 404±113 ml, 798±230 ml, P〈0. 05）. （2） The hemoglobin level in group C （94±45 g/L） was lower than that in group A （110±22 g/L） and group B （103±24 g/L） （P〈0.05）. However, there was no significant difference in the level of hemoglobin between group A and B. （3） There was no significant difference in the incidence of acute renal failure （ARF） among the 3 groups. The incidence of acute respiratory distress syndrome （ARDS） of group C （31.2%） was higher than that of group A （16.7%） and group B （18.2%） （P〈0.05）. The mortality of group C （34.4%） was higher than that of group A （12. 5% ） and group B （12. 1% ） （P〈0.05）. Conclusion： Preoperative limited resuscitation applied on patients with traumatic shock can reduce blood loss, incidence of ARDS and mortality.

Correlation between heat shock protein 70 expression in the brain stem and sudden death after experimental traumatic brain injury

Objective:Theaimof thisstudywas to determinethepatternsof heat-shockprotein70(HSP 70 )biosynthesis followingtraumaticbraininjury,andobservetheeffectof HSP 70 inductionon thefunctionof thevitalcenterinthebrain stem.Methods:Ratmodelsof suddendeathresultedformtraumaticbraininjurywereproduced,andHSP 70 expressionin theratbrainstemwasdeterminedby immunohistochemistry,theinductionof HSP 70 mRNAdetectedby RT-PCR.Re -sults: Thelevelof HSP 70 mRNAwasprominentlyelevatedinthebrainstemas earlyas15minfollowingtheimpactin-jury,whileHSP 70 expressionwasonlyobserved3to6h aftertheinjury.Itwasalsoobservedthatthelevelsof HSP 70 mR-NAbutnottheproteinwereelevatedinthebrainstemof suddendeathrats.Conclusion:Thesynthesisof HSP 70 wassig-nificantlyenhancedinthebrainstemfollowingtraumaticinjury,andtheexpressionof HSP 70 is beneficialto eliminatethe stressagents,andto sustainthecellularproteinhomeostasis.Whentheinjurydisturbsthesynthesisof HSP 70 to disarmthe protectivemechanismof heat-shockproteins,dysfunctionof thevitalcenterinthebrainstem,andconsequentlydeathmay occur.Breachinthesynchronizationof HSP 70 mRNA-proteincanbeindicativeof fataldamageto thenervecells.

Correlation Study of Neurotransmitter and Immune Levels in Pre-Hospital Emergency Nurses with Post-Traumatic Stress Disorder

Objective: To investigate the occurrence of PTSD in pre-hospital emergency nurses and its related factors, and to compare the differences of neurotransmitter and immune-related factors between pre-hospital emergency nurses who experienced traumatic events and those who did not develop PTSD and healthy people. How: Post-traumatic Stress Disorder Self-Rating Scale (PCL-C) tests were performed on pre-hospital emergency nurses in PTSD group, non-PTSD group and healthy control group, and the plasma monoamine neurotransmitters and serum cytokines were determined by double-antibody sandwich ABC-ELISA assay using enzyme-linked adsorption kit provided by Shanghai Xitang Biotechnology Co., Ltd. Results: 1) There were statistically significant differences in PCL-C scores between PTSD group, non-PTSD group and healthy group (p α between PTSD group, non-PTSD group and healthy group (p Conclusion: Pre-hospital emergency nurses should have early psychological intervention and guidance to reduce the occurrence of PTSD in emergency and emergency nurses.

Analysis of Shock Acceleration by Dotting of Finger Braille and Influence of Postures of Receiver＇s Hand

Finger Braille is one of the tactual communication media of deafblind people. In one-handed Finger Braille, a sender dots the left part of the Braille code on the Distal Interphalangeal （DIP） joints of the index, middle and ring fingers of a receiver, and subsequently dots the right part of the Braille code on the Proximal Interphalangeal （PIP）joints of the same fingers. Because there is a small number of non-disabled people who are skilled in Finger Braille, deafblind people communicate in this medium only through an interpreter. We have been developing a Finger Braille recognition system using small piezoelectric accelerometers worn by the receiver To recognize the dotted positions （DIP or PIP joints）, we have made a hypothesis that the dotting on the DIP joints causes a hard impact, and the dotting on the PIP joints causes a soft impact, when the receiver＇s hand forms a natural longitudinal arch on the desk. The difference of each impact is indicated by its damping amplitude ratio. In this paper, a measurement experiment about the postures of the receiver＇s hand was conducted. The postures of the receiver＇s hand were as follows： forming the natural longitudinal arch on the desk and fully contacting the desk. As a result, the dotting on the DIP joints of both postures caused the hard impacts; the dotting on the PIP joints caused the soft impact when the receiver＇s hand formed the natural longitudinal arch; the dotting on the PIP joints caused the hard impact when the receiver＇s hand fully contacted the desk. Therefore, we could verify the hypothesis.

基于5G专网的院前急救运作模式、体系对创伤失血性休克患者凝血功能及炎性因子的影响研究

目的研究基于5G专网的院前急救运作模式、体系对创伤失血性休克患者凝血功能及炎性因子的影响。方法应用医学研究随机数字表法,选取我院2020年8月—2023年8月收治的创伤失血性休克患者100例,按照治疗路径不同分为对照组和观察组,对照组给予常规救治模式治疗,观察组给予基于5G专网的院前急救运作模式、体系治疗,比较两组凝血功能、炎性因子以及抢救总有效率。结果观察组PT、APTT、TT、FIB指标水平均低于对照组,PLT水平高于对照组(均P<0.05);观察组TNF-α、IL-1、IL-6、CRP等炎性因子指标水平以及抢救总有效率均低于对照组(均P<0.05)。结论基于5G专网的院前急救运作模式、体系对创伤失血性休克能明显改善患者的凝血功能,降低炎性因子指标水平,升高抢救有效率。

罂粟碱在创伤休克大鼠肠损伤保护作用研究

目的研究罂粟碱对创伤休克大鼠肠损伤保护作用。方法选择SD大鼠20只,随机分成2组,对照组采用股骨创伤法建立创伤性休克大鼠模型,建模后常规液体复苏。实验组在对照组基础上予罂粟碱1.5 mg/kg加入50 mL生理盐水微量泵24小时持续注入。24小时后分别抽血检测血清肠型脂肪酸结合蛋白(IFABP)、二胺氧化酶(DAO)、炎症因子TNF-α、IL-6浓度。结果(1)创伤休克24小时大鼠血清IFABP、DAO及血清炎症因子TNF-α、IL-6浓度明显升高。(2)加用罂粟碱干预后大鼠血清IFABP、DAO及血清炎症因子TNF-α、IL-6浓度较对照组明显降低。结论罂粟碱能减轻创伤休克大鼠肠道损伤,降低全身炎症反应。

白蛋白与血红蛋白/白蛋白评估创伤失血性休克患者预后的临床研究

目的探究白蛋白(ALB)和血红蛋白/白蛋白(HB/ALB)对创伤失血性休克(THS)患者预后的预测价值。方法回顾性分析2020年1月—2021年12月南京医科大学第一附属医院行创伤绿色通道的90例THS患者数据,根据7 d内是否死亡分为生存组(n=76)与死亡组(n=14)。比较两组人口学资料、院前时间、GCS、生命体征、ISS、入院首次实验室结果、入院24 h内的补液输血情况、结局指标。受试者工作特征(ROC)曲线下面积确定各预测指标的截断值,单因素与多因素Logistic回归分析预测7 d死亡的独立危险因素,并根据HB/ALB的截断值分组,绘制生存曲线,评估与各次要结局指标之间的关系。结果90例THS患者中,男性62例,女性28例;年龄18~84岁,平均46.9岁;7 d内死亡14例(15.6%)。死亡组与生存组之间年龄[(56.8±16.6)岁vs.(45.0±18.3)岁]、GCS(12分vs.15分)、ISS(29分vs.19分)、尿素氮[(8.0±2.6)mmol/L vs.(5.6±2.0)mmol/L]、肌酐(100.8 mol/L vs.61.3 mol/L)、ALB[(23.2±4.0)g/L vs.(30.2±6.6)g/L]、PT(15.7 s vs.13.6 s)、APTT(34.9 s vs.28.3 s)比较差异有统计学意义(P<0.05)。多因素回归分析发现ALB≤28.1 g/L(OR=112.791,95%CI:1.663~7647.721,P=0.028)、GCS≤13分(OR=18.293,95%CI:1.037~322.820,P=0.047)是7 d死亡的独立危险因素。通过绘制7 d生存曲线发现HB/ALB>3.3患者的病死率明显高于HB/ALB≤3.3患者,同时发生多器官功能障碍综合征、使用机械通气以及入住重症监护室的概率明显升高。结论早期ALB水平能预测THS患者的预后情况,ALB≤28.1 g/L提示THS患者预后不佳。HB/ALB>3.3对THS患者的多器官功能障碍综合征、使用机械通气以及入住ICU等次要预后也有不良影响,动态监测ALB与HB/ALB对于评估复苏情况、指导复苏有一定意义。

下腔静脉变异指导液体复苏对创伤失血性休克患者血栓弹力图、炎症因子的影响及预后相关分析

目的探讨基于B超的下腔静脉变异指导液体复苏模式对创伤失血性休克患者血栓弹力图、炎症因子的影响及不同液体复苏模式与患者预后的联系。方法选取2020年1月—2022年6月我院收治的创伤失血性休克患者104例,依据随机数表法将其分为对照组和观察组,每组52例。对照组接受常规限制性液体复苏,观察组接受基于B超的下腔静脉变异指导液体复苏。比较两组患者临床资料、血栓弹力图指标[凝血反应时间(R),血凝块形成时间(K)、血凝块最大强度]、炎症因子[肿瘤坏死因子α(TNF-α)、白介素-6(IL-6)、IL-10]差异。根据104例患者28 d内死亡、多器官功能障碍综合征、急性呼吸窘迫综合征发生情况分为为预后不良组(n=23)和预后良好组(n=81)。采用二元Logistics回归分析影响预后的因素,探究不同液体复苏模式与预后的联系。结果与对照组比较,观察组患者输液量、输血量、ICU住院时间更少(P<0.05);干预1 h,R、K更低,血凝块最大强度更大(P<0.05);干预1 h,TNF-α、IL-6、IL-10更低(P<0.05)。与预后良好组相比,预后不良组患者发病至入院时间≥6 h、限制性液体复苏占比更大,休克指数、ISS评分更高(P<0.05)。以发病至入院时间(<6 h=1,≥6 h=0)、液体复苏模式(下腔静脉变异指导=1,限制性液体复苏=0)、休克指数、ISS评分为自变量,预后(预后不良=1,预后良好=0)为因变量,二元Logistics回归分析显示液体复苏模式、发病至入院时间、ISS评分是影响预后不良的因素(P<0.05)。结论基于B超的下腔静脉变异指导液体复苏可提升患者康复与治疗效率,改善血栓弹力图、炎症反应,是改善预后的保护性因素。

床旁超声辅助下的个性化液体管理对创伤失血性休克患者预后的影响研究

目的探讨床旁超声辅助下的个性化液体管理对创伤失血性休克(HTS)患者预后的影响。方法将2023年2月至2024年1月急诊重症监护病区(EICU)接受治疗的HTS患者50例根据液体管理方式不同分为接受中心静脉压(CVP)引导下液体管理的对照组(n=25例)和接受床旁超声引导下个体化液体管理的观察组(n=25),比较2组患者生命体征、动脉血气分析指标、尿量情况、血管活性药物应用时间、机械通气时间、住ICU时间、复苏期间并发症发生情况及存活情况。结果观察组心率(HR)、呼吸频率(RR)及平均动脉压(MAP)改善均优于对照组(P<0.05);观察组动脉血二氧化碳分压(PaCO_(2))、血乳酸水平均低于对照组(P<0.05),而动脉血氧分压(PaO_(2))、氧合指数(OI)及尿量均高于对照组(P<0.05);观察组血管活性药物应用时间、机械通气时间及住ICU时间均短于对照组(P<0.05);观察组并发症发生率为16.00%低于对照组的44.00%(P<0.05);观察组存活率为92.00%高于对照组的68.00%(P<0.05)。结论个性化液体管理在床旁超声辅助下应用于创伤失血性休克患者具有显著的预后效果。

3D打印技术在生物医学领域的应用进展

生物材料可用于人体组织及器官的修复,对多种疾病的治疗具有积极作用,尤其是与3D打印技术相结合,可在医疗领域发挥革命性的影响力。目前,3D打印技术在生物医学领域的应用已经得到广泛的研究,如利用3D打印获得患处解剖模型以辅助精确医疗。本文综述了3D打印技术在生物医药领域的应用,并就其未来发展方向进行讨论。

基于危机管理理论的全方位急诊护理对创伤性颅脑损伤患者的影响

目的:探究基于危机管理理论的全方位急诊护理对创伤性颅脑损伤患者的影响。方法:回顾性选取2023年1—12月厦门大学附属第一医院急诊科收治的100例创伤性颅脑损伤患者。根据不同护理方法将其分为观察组和对照组,各50例。对照组实施常规急诊护理,观察组在对照组基础上实施基于危机管理理论的全方位急诊护理。比较两组时间指标、并发症、相关指标。结果:观察组确诊时间、急诊科抢救时间、急诊转送至手术时间均早于对照组,住院时间短于对照组,差异有统计学意义(P<0.05)。观察组并发症发生率低于对照组,差异有统计学意义(P<0.05)。出院时,两组格拉斯哥昏迷评分法(GCS)评分、卡式功能状态量表(KPS)评分均升高,美国国立卫生研究院卒中量表(NIHSS)评分降低,观察组GCS评分、KPS评分均高于对照组,NIHSS评分低于对照组,差异有统计学意义(P<0.05)。结论:基于危机管理理论的全方位急诊护理可提高抢救效果,还可保证患者的健康安全。

损伤控制联合外伤急救在急诊创伤性颅脑损伤中的应用效果

目的探讨急诊创伤性颅脑损伤外伤急救与损伤控制联合干预的效果。方法选取2020年2月至2023年2月厦门大学附属第一医院收治的急诊创伤性颅脑损伤患者100例,依据干预方法分为研究组和对照组各50例。研究组采取院前外伤急救联合院内损伤控制干预,对照组采取常规干预,比较两种患者的治疗效果。结果研究组患者的抢救时间短于单独干预组,D-D、TT、PT、APTT、NLR水平均低于单独干预组,rScO2、PAV、RAGE水平均高于单独干预组,APACHEⅡ评分、ISS评分、DIC评分均低于单独干预组,GCS评分、GOS评分、KPS评分均高于单独干预组,NDS评分、NIHSS评分均低于单独干预组,LOTCA评分、FMA评分、BI评分、SF-36评分均高于单独干预组,总有效率高于单独干预组,并发症发生率低于单独干预组(P值均<0.05)。结论急诊创伤性颅脑损伤外伤急救与损伤控制联合干预的效果较外伤急救单独干预好。

不同冰冻血浆与红细胞比例输血方案治疗创伤失血性休克的效果分析

目的对不同冰冻血浆与红细胞比例输血方案治疗创伤失血性休克的效果进行分析。方法回顾性选取2021年6月—2023年6月济宁市第一人民医院接受相关治疗的84例创伤失血性休克患者的临床资料,按照不同输血方案,分为参照组(42例)及研究组(42例)。参照组使用冰冻血浆∶红细胞比例为1∶2的输血方案对干预治疗,研究组使用冰冻血浆∶红细胞比例为1∶1的输血方案对干预治疗。对比两组输血前及输血后的凝血功能指标以及输血前、输血后的血栓弹力图(Thromboela-stogram,TEG)参数水平。结果研究组输血后的凝血功能指标水平优于参照组,差异有统计学意义(P<0.05);输血后研究组α角(68.55±5.38)°、MA(62.84±5.47)mm、K(2.63±0.61)min、R(4.37±1.33)min等TEG参数水平均优于参照组,差异有统计学意义(t=9.085、9.005、5.407、3.774,P均<0.001)。结论对创伤失血性休克患者实施1:1的冰冻血浆:红细胞输血方案可获得理想治疗效果,不仅可强化患者凝血功能,并且可在一定程度上提升患者血栓弹力图参数水平,对患者身体康复发挥着一定促进作用。

爆炸冲击波性脑损伤的发生机制和生物标志物研究进展

爆炸冲击波性脑损伤(blast-induced traumatic brain injury,bTBI)是由爆炸时的冲击波对颅脑造成的损伤效应,伤者可表现出不同程度的躯体和行为障碍以及远期认知功能损害,是战时最常见的脑损伤类型。bTBI的发生机制复杂且尚未完全阐明。爆炸产生的冲击波作用于头部表面并在颅内传播,造成颅脑弥漫性损伤,从病理学层面可将bTBI分为原发性损伤和继发性损伤。冲击波的机械致伤效应会造成脑内结构的原发性受损,通常不可逆,只能采取有效的预防措施减少伤害。原发性损伤可引发一系列复杂的继发性级联反应,包括突触功能障碍、兴奋性毒性损伤、血脑屏障破坏、脑膜淋巴系统功能障碍、神经炎症、线粒体功能障碍、氧化应激反应、tau蛋白过度磷酸化和淀粉样蛋白-β病理改变等,可持续至伤后数天甚至慢性阶段,为临床治疗提供了干预的时间窗。轻度bTBI临床表现异质性高,影像学表现常呈阴性,早期诊断困难。但近年来bTBI的血液生物标志物取得长足进展,包括泛素C末端水解酶L1、神经元特异性烯醇化酶、神经丝蛋白轻链、磷酸化tau蛋白、髓鞘碱性蛋白、胶质纤维酸性蛋白、S100钙结合蛋白B和其他新兴生物标志物等,有望成为影像学阴性的bTBI的早期诊断和预后判断的潜在生物标志物。综上,本文重点综述了近年来关于bTBI的发生机制和生物标志物研究的前沿进展,并展望了未来的研究方向,以期为探索bTBI的发生机制、早期诊断策略和干预靶点提供新思路。

多发性骨折创伤失血性休克患者疾病转归的预测模型构建与验证

目的构建多发性骨折创伤失血性休克患者疾病转归的预测模型,并进行内外部验证。方法选取2023年1月至2024年1月于山东大学齐鲁医院德州医院就诊的126例多发性骨折创伤失血性休克患者作为建模集用于模型构建,另外100例多发性骨折创伤失血性休克患者作为验证集用于模型验证。根据建模集患者院内疾病转归情况分为存活组(n=95)、死亡组(n=31),比较两组临床资料,采用单因素和多因素Logistic回归分析确定影响多发性骨折创伤失血性休克患者疾病转归的危险因素,根据筛选的危险因素构建预测模型,经受试者工作特征(ROC)曲线、校准曲线来评估模型预测效能,临床决策曲线分析(DCA)预测模型的临床实用性和获益率。结果死亡组年龄≥60岁(83.87%vs.30.53%)、合并基础疾病(29.03%vs.10.53%)、合并颅内出血(38.71%vs.15.79%)、受伤至急诊时间>4 h(64.52%vs.33.68%)、损伤严重程度(ISS)评分(分:33.54±4.52 vs.29.89±3.42)、6 h乳酸值(mmol/L:5.21±0.22 vs.3.32±0.87)、活化部分凝血活酶时间(APTT,s:39.90±3.45 vs.36.42±2.94)、凝血酶时间(TT,s:17.21±2.87 vs.15.45±1.76)、凝血酶原时间(PT,s:16.98±2.19 vs.14.23±1.98)高于存活组,格拉斯哥昏迷(GCS)评分(分:4.53±0.98 vs.10.23±2.42)、纤维蛋白原(Fib,g/L:2.34±0.32 vs.3.87±0.33)低于存活组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示,受伤至急诊时间(OR=3.898,95%CI 1.287~8.275)、GCS评分(OR=3.978,95%CI 1.814~7.989)、ISS评分(OR=2.342,95%CI 1.191~4.375)、6 h乳酸值(OR=2.881,95%CI 1.239~5.689)、Fib(OR=2.543,95%CI 1.198~5.389)是多发性骨折创伤失血性休克患者死亡的独立危险因素(P<0.05)。基于受伤至急诊时间(X_(1))、GCS评分(X_(2))、ISS评分(X_(3))、6 h乳酸值(X_(4))、Fib(X_(5))构建多发性骨折创伤失血性休克患者死亡风险的列线图预测模型。建模集中预测模型的AUC为0.897(95%CI 0.723~0.923),验证集中预测模型的AUC为0.901(95%CI 0.786~0.955)。校准曲线发现,在两个数据集中多发性骨折创伤失血性休克患者死亡风险的预测概率与实际发生率接近。DCA分析发现,列线图预测模型曲线远离净获益为0的参考线和所有样本均为阳性的参考线,提示预测模型预测价值良好。结论受伤至急诊时间、GCS评分、ISS评分、6 h乳酸值、Fib是多发性骨折创伤失血性休克患者死亡的独立危险因素,据此构建的列线图预测模型区分度、校准度较高,能够为临床早期评估患者疾病转归和干预提供理论依据。