中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2015年
6期
427-432
,共6页
赵红亮%刘蕊芝%张芸华%牛东升
趙紅亮%劉蕊芝%張蕓華%牛東升
조홍량%류예지%장예화%우동승
创伤严重度指数%创伤和损伤%病死率
創傷嚴重度指數%創傷和損傷%病死率
창상엄중도지수%창상화손상%병사솔
Trauma severity indices%Wounds and injuries%Fatality rate
目的 探讨新创伤评分法即格拉斯哥昏迷评分(GCS)、年龄和收缩压评分(GAP)对急诊创伤患者的伤情判定和病死率预测的准确性.方法 收集27 706例急诊创伤患者的临床资料.观察终点分为3类:到达急诊科或急救中心后24 h内死亡,即24 h死亡;到达急诊科或急救中心24h至到达急诊科或急救中心7d死亡,即24 h后死亡;其他创伤患者均视为存活.在创伤机制、GCS、年龄和收缩压评分(MGAP)的基础上,采用GAP方法对急诊创伤患者的院内病死率进行预测和伤情的判定,对比分析GAP预测病死率的准确性与修正创伤评分(RTS)、创伤严重程度评分(TRISS)和MGAP的差异.各项评分方法对创伤患者病死率的预测准确性计算采用C-statistics方法.结果 GAP预测24 h后病死率和24 h病死率的C值(0.936和0.961)分别比RTS(0.917和0.958)和MGAP(0.920和0.950)高,但略低于TRISS(0.950和0.970).GAP方法将3～ 10分判定为重伤,11～ 18分判定为缓和伤,19～24分判定为轻伤.结论 GAP方法具有简便、实用性强、伤情判定和病死率预测准确性高的特点,可帮助医生制定合理的救治方案.
目的 探討新創傷評分法即格拉斯哥昏迷評分(GCS)、年齡和收縮壓評分(GAP)對急診創傷患者的傷情判定和病死率預測的準確性.方法 收集27 706例急診創傷患者的臨床資料.觀察終點分為3類:到達急診科或急救中心後24 h內死亡,即24 h死亡;到達急診科或急救中心24h至到達急診科或急救中心7d死亡,即24 h後死亡;其他創傷患者均視為存活.在創傷機製、GCS、年齡和收縮壓評分(MGAP)的基礎上,採用GAP方法對急診創傷患者的院內病死率進行預測和傷情的判定,對比分析GAP預測病死率的準確性與脩正創傷評分(RTS)、創傷嚴重程度評分(TRISS)和MGAP的差異.各項評分方法對創傷患者病死率的預測準確性計算採用C-statistics方法.結果 GAP預測24 h後病死率和24 h病死率的C值(0.936和0.961)分彆比RTS(0.917和0.958)和MGAP(0.920和0.950)高,但略低于TRISS(0.950和0.970).GAP方法將3～ 10分判定為重傷,11～ 18分判定為緩和傷,19～24分判定為輕傷.結論 GAP方法具有簡便、實用性彊、傷情判定和病死率預測準確性高的特點,可幫助醫生製定閤理的救治方案.
목적 탐토신창상평분법즉격랍사가혼미평분(GCS)、년령화수축압평분(GAP)대급진창상환자적상정판정화병사솔예측적준학성.방법 수집27 706례급진창상환자적림상자료.관찰종점분위3류:도체급진과혹급구중심후24 h내사망,즉24 h사망;도체급진과혹급구중심24h지도체급진과혹급구중심7d사망,즉24 h후사망;기타창상환자균시위존활.재창상궤제、GCS、년령화수축압평분(MGAP)적기출상,채용GAP방법대급진창상환자적원내병사솔진행예측화상정적판정,대비분석GAP예측병사솔적준학성여수정창상평분(RTS)、창상엄중정도평분(TRISS)화MGAP적차이.각항평분방법대창상환자병사솔적예측준학성계산채용C-statistics방법.결과 GAP예측24 h후병사솔화24 h병사솔적C치(0.936화0.961)분별비RTS(0.917화0.958)화MGAP(0.920화0.950)고,단략저우TRISS(0.950화0.970).GAP방법장3～ 10분판정위중상,11～ 18분판정위완화상,19～24분판정위경상.결론 GAP방법구유간편、실용성강、상정판정화병사솔예측준학성고적특점,가방조의생제정합리적구치방안.
Objective To investigate the accuracy of the new trauma scoring method:Glasgow coma score (GCS),age and systolic pressure score (GAP),in diagnosing patients' traumatic condition and predicting fatality rate in department of emergency.Methods The chnical data of 27 706 traumatic patients in department of emergency were collected.The observation was categorized into three kinds:death within 24 h after reaching department of emergency (24 h death);death from 24 h after reaching department of emergency to 7 d (death after 24 h);survival.On the basis of the trauma mechanism,GCS,age and systolic pressure score (MGAP),the GAP method was used for judging traumatic condition and predicting fatality rate of traumatic patients in department of emergency.The accuracy of GAP in predicting fatality rate was compared with revised trauma score (RTS),trauma and injury severity score (TRISS) and MGAP.The C-statistics method was used to calculate the accuracy in predicted the fatality rate.Results The C values (0.936 and 0.961) of GAP in predicting fatality rate after 24 h and in 24 h were higher than RTS (0.917 and 0.958) and MGAP (0.920 and 0.950),but slightly lower than TRISS (0.950 and 0.970).The traumatic condition in GAP was defined in this way:severity 3-10 scores,moderation 11-18 scores,and slightness 19-24 scores.Conclusions The GAP is simple,practical and accurate in diagnosing patients' traumatic condition and predicting their fatality rate.It is helpful in physicians' decision of a proper treatment plan.
