CAJ | 학술논문

目的总结汶川地震后胸外伤病人的特点,比较不同伤情评估方法对预测伤员可能发生呼吸衰竭的差别,为灾难发生后的救治决策提供参考.方法 2008年5月12日到27日,共入院治疗地震伤员1823例.其中184例(10.1%)被确诊受了胸部外伤.详细记录这组病人的一般资料、诊断、治疗过程以及结局.通过Logistic回归分析导致病人发生呼吸衰竭的危险因素;通过绘制伤者特征(Roc)曲线比较损伤严重度评分(ISS)、新损伤严重度评分(NISS)和胸部外伤指数对地震伤病人呼吸衰竭的预测效果.结果地震后胸外伤以复合伤为主,占84.78%;呼吸衰竭发生率高达20.65%(38例),且带机时间长,3.72 d,平均(18.82±15.94) d.Logistic 回归分析显示仅连枷胸、肺挫伤和挤压综合征的出现与伤后呼吸衰竭的发生有关.ROC曲线显示在预测呼吸衰竭的发生上,NISS曲线下面积大于ISs和胸部外伤指数,以得分24为标准预测呼吸衰竭,其敏感度为94.74%,特异性为79.45%.结论地震后获救胸外伤员伤情复杂,呼吸衰竭发生率高,是导致死亡的主要原因.NISS评分可有效地预测地震伤后呼吸衰竭的发生,其最佳阈值为24.应在震后伤情评估中予以推广.
목적 총결문천지진후흉외상병인적특점,비교불동상정평고방법대예측상원가능발생호흡쇠갈적차별,위재난발생후적구치결책제공삼고.방법 2008년5월12일도27일,공입원치료지진상원1823례.기중184례(10.1%)피학진수료흉부외상.상세기록저조병인적일반자료、진단、치료과정이급결국.통과Logistic회귀분석도치병인발생호흡쇠갈적위험인소;통과회제상자특정(Roc)곡선비교손상엄중도평분(ISS)、신손상엄중도평분(NISS)화흉부외상지수대지진상병인호흡쇠갈적예측효과.결과 지진후흉외상이복합상위주,점84.78%;호흡쇠갈발생솔고체20.65%(38례),차대궤시간장,3.72 d,평균(18.82±15.94) d.Logistic 회귀분석현시부련가흉、폐좌상화제압종합정적출현여상후호흡쇠갈적발생유관.ROC곡선현시재예측호흡쇠갈적발생상,NISS곡선하면적대우ISs화흉부외상지수,이득분24위표준예측호흡쇠갈,기민감도위94.74%,특이성위79.45%.결론 지진후획구흉외상원상정복잡,호흡쇠갈발생솔고,시도치사망적주요원인.NISS평분가유효지예측지진상후호흡쇠갈적발생,기최가역치위24.응재진후상정평고중여이추엄.
Objeatve To summarize the characteristic of thoracic injury patients in earthquake of Wenchuan，China.And to validme the accuracy of the injury severity score(ISS).the new injury severity score (NISS)and the chest injury index (Cn)for re-diction of respiratory faihhure.Methods 1823 patients injured in earthquake of Wenchuan were transter to West China Hospital,Si-chuan University from May 12 to May 27.184(10.1％)of these 1823 patients had suffered chest injury.They were ncluded in this cohort study.The risk factors of respiratory failure were analyzed with unconditional Logisticregtession.The predictive accuracies of ISS,NISS and CN were compared with receiver operator characteristic(ROC) curves.Results 156 patients(84.78％)had suffered injury more that one organ.38 patients developed respiratory failure with the incidence of 20.65％.The duration of mechanical venti- iation isfrom 3 to 72 days [mean(18.82±15.94)days].The occurrence of flail chest,pulmonary contusion and crush syndrome was shown to be the risk factor of respiratory faihure.There were statistical differences in the ROC curve between NISS with the two other trauma scores for predicationof respiratory faihure.The best cutoff point of NISS was 24 with the sensitivity of 94.74& and specificity of 79.45％.Conclusion Chest injury in earthquake is of ten companied with multiple injuries.The incidence of res-piratory failure is high.The New Injury Severity Score can accurately predict the development of respiratory failure in chest injury pa-tients.We recommend the NISS should be considered as a useful tool for trauma evaluation．