摘要
目的探讨损伤严重程度评分(injury severity score,ISS)在重度创伤患者病情中的评估作用与预后相关性。方法回顾性分析2011年1月—2013年5月我科救治的较重多发创伤1556例临床资料,比较ISS≥50的重度创伤患者(99例)与16≤ISS<50严重创伤患者(1457例)在致伤机制、入院前情况、住院治疗情况及治疗结果等方面的差异。结果 ISS≥50组摩托车致伤者显著高于ISS评分<50组。ISS≥50组平均损伤3.8个部位,ISS<50组平均损伤2.3个部位(P<0.05)。在ISS≥50组胸部联合下肢损伤和胸部联合脊髓损伤发生率高于ISS<50组(P<0.05)。入院前的休克、意识障碍以及实施气管插管、心肺复苏和两次转诊患者的比例,ISS≥50组均高于ISS<50组P<0.05),多器官衰竭发生率在ISS≥50组显著高于ISS<50组(P<0.05)。ISS≥50组接受手术台数、住ICU时间、气管插管时间均高于ISS<50组(P<0.05)。ISS>50组住院日平均73 d,病死率32.3%,诊断为重型颅脑损伤并伴严重的感觉运动功能障碍的患者经治疗获得中等以上好转。ISS<50组住院日平均49 d,病死率12.3%,两组比较差异有统计学意义(P<0.05)。结论影响重度多发伤预后的因素较多,ISS可作为评估损伤严重程度和预后的可靠工具,但并不能准确预测多发伤患者的最终治疗结果,即使是ISS评分>50患者经过及时系统的治疗也会有较好预后。
Objective To explore the correlation between evaluation significance and prognosis of injury severity score （ISS） in patients with severe trauma.Methods Clinical data of 1556 patients with severe multiple trauma during January 2011 and May 2013 was retrospectively analyzed,and injury mechanisms,conditions before admissions,treatments during admissions and therapy outcomes between 99 patients in severe trauma group （group A,ISS≥50） and 1457 patients in serious trauma group （group B,16 ≤ ISS ＜ 50） were compared.Results The number caused by motorcycle collision in group A was significantly higher than that of in group B.The average injured body regions were 3.8 in group A and 2.3 in group B （P ＜ 0.05）.Injuries incidence rates of chest complicated with lower limbs and chest complicated with spinal cord in group A were higher than those of in group B （P ＜ 0.05）.The ratios of shock before admissions,disturbance of consciousness,tracheal intubation,cardiopulmonary resuscitation and proportion of patients transferred treatment twice in group A were significantly higher than those in group B （P ＜ 0.05）,and the incidence rate of multiple organ failure in group A was significantly higher than that of in group B （P ＜ 0.05）.The frequency of operation,days of stay in ICU and duration of tracheal intubation in group A were higher than those of in group B （P ＜ 0.05）.In group A,the mean hospitalization day was 73 d,the mortality rate was 32.3％,and patients diagnosed as having severe craniocerebral injury complicated with motor dysfunction attained moderate amelioration after treatment.In group B,the mean hospitalization day was 49 d,the mortality rate was 32.3％,and the differences were statistically significant （P ＜ 0.05）.Conclusion There are many factors influencing the prognosis of severe multiple traumas.ISS can be used as an reliable method for evaluating injuries degrees,but it is hard to accurately predict treatment outcomes of patients with severe multiple traumas,because of patients with ISS scores more than 50 scores can get better prognoses after timely and systemic treatments.
出处
《临床误诊误治》
2014年第1期7-10,共4页
Clinical Misdiagnosis & Mistherapy
基金
2011陕西省社会发展攻关项目(项目编号:2011K16-02-06)
国家自然科学基金资助项目(81070063)
