胸部穿透伤损伤严重度新评分方法初探

目的　建立对胸部穿透伤(PTT)更敏感、准确的新创伤评分法。　方法　将 1 018例PTT患者分成生存组和死亡组。比较两组伤后时间和各种生理参数的差异,选取在两组间差别有统计学意义的指标作为新评分参数。用Logistic回归分析计算各参数的权重系数,得出新评分方法———胸部穿透伤进程评分 (PTTCS)。评价PTTCS和RTS对PTT患者生死结局的预测效果。结果　新评分方法的数学模型为:PTTCS= 1. 210G-0. 835S+1. 034P+0. 583T-1. 982,公式中G、S、P、T分别为格拉斯哥昏迷评分(GCS)、收缩压(SBP)、脉压(PP)和伤后时间(T)的编码值。与RTS比较,PTTCS预测PTT结局的敏感性、特异性和准确性显著提高,死亡误判率明显降低。PTTCS分值与患者的死亡率呈现明显的负相关关系(r=0. 84,P<0. 01)。　结论　PTTCS方法可行,对PTT结局的预测效果优于RTS。

New injury severity score of penetrating thoracic trauma:a pilot study

Objective To establish a more sensitive and accurate trauma scoring methods that suit patients with penetrating thoracic trauma (PTT). Methods A total of 1 018 patients with PTT were reviewed retrospectively and divided into survival group and death group. The post-trauma time, various physiologic data and trauma scores were compared between both groups; then, the statistically significant data between survival and death groups were selected as new trauma score parameters. The weight coefficients of every parameter were determined through Logistic regression for establishment of a mathematic model of new trauma score, ie, penetrating thoracic trauma course score (PTTCS). The predictive effectiveness of PTTCS and RTS were appraised and compared. Results The mathematic model of PTTCS was expressed as: PTTCS= 1.210G-0.835S+1.034P+0.583T-1.982, where G, S, P and T were the coded value of GCS, SBP (systole blood pressure), PP(pulse pressure) and T (post-trauma time) respectively. Compared with RTS, PTTCS in predicting outcome revealed more remarkable improvement in aspects of sensitivity, specificity and accuracy as well as lower rate of erroneous judgement for death. There was a negative correlation between PTTCS and the mortality of patients, with correlation coefficient of 0.84 (P<0.01). Conclusion PTTCS method is feasible and reliable and has better predictive effect for PTT outcome than RTS.