不同创伤评分系统在评估胸部创伤严重程度及预后的价值比较

目的探讨不同创伤评分系统在评估胸部创伤严重程度及胸部创伤预后的判断效果。方法回顾性分析遂宁市中心医院胸心外科2008年1月—2012年5月收治的880例胸部创伤患者的临床资料，运用受试者工作特征曲线（ROC曲线）下面积，单因素和多因素分析评价创伤指数（rrI）、修正创伤记分（RTS）、损伤严重度评分（ISS）、序贯器官衰竭评估评分（SOFA）对胸部创伤预后的预测能力。结果通过ROC曲线下面积比较，结果发现RTS、ISS、SOFA3个评分系统对胸部创伤预后结果均具有良好的判别能力而以ISS的预后判别能力为最佳，但TI对胸部创伤预后结果的判别能力差。3种评分系统联合运用表明：ISS〉16分、SOFA〉111分、RTS≤8分，三者阳性与二者阳性或一个阳性或三者均阴性的胸部创伤患者病死率有统计学差异（P〈0．05）。结论RTS、ISS、SOFA对胸部创伤预后判别虽然稍有差别，但3种评分系统的动态评分对胸部创伤，尤其是重症胸部创伤的预后均有较强的判别预测能力，如果联合三者建立相应的判别方程对胸部创伤预后的判断可能具有更佳的判别效果。

Value of different trauma scoring system in assessment of chest trauma severity and prognosis

Objective To investigate the severity and prognosis of different trauma scoring system in evaluating judgment of chest trauma. Methods The clinical data of 880 patients with thoracic trauma treated in the Central Hospital of Suin- ing from January 2008 to May 2012 were retrospectively analysis, using the area under the receiver -operating character- istic curve （ROC curve） , by the single factor and multiple factor evaluation of trauma index （TI） ,revised trauma score （RTS）, injury severity score （ISS）, sequential organ failure assessment score （SOFA） were analysis and predictived a- bility for prognosis of chest trauma. Results By comparing the area under the ROC curve,it found that the RTS, ISS and SOFA scoring systems for chest trauma results, had good prognosis judging ability, the prognosis of ISS discriminant abili- ty was the best, hut TI discriminant ability of chest trauma outcome was low. Use of three scoring system joint showed that the ISS 〉 16 points, SOFA ≥ 11 points, RTS ≤ 8 pointsand the three positive and both positive, or a positive or all nega- tive patients with chest trauma fatality rate was statistically difference （ P 〈 0.05 ）. Conclusion Although RTS, ISS, SO- FA of chest trauma prognosis judging differ slightly, but for three kinds of dynamic observation and grading of chest trau- ma scoring system, especially the prognosis of severe chest trauma with strong discrimination ability to predict, if com- bined the three corresponding discriminant equation of thoracic trauma judgment method ,it may have a better prognosis.