不同休克指数在急诊创伤患者预后中的预测价值
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摘要
目的:探讨不同休克指数对急诊创伤患者预后中的评估价值,为临床工作者提供医疗决策和治疗指导的依据。方法:选取2016-01—2017-12期间抢救室收治的1 439例创伤患者,其中男1 062例,女377例。以28d预后为终点,将患者分为生存组和死亡组,对比2组患者不同休克指数等临床参数,分析其与预后的关系;将患者按照rSIG分为<9组、9～15组、>15组,比较3组患者病死率的差异。结果:存活组的休克指数、改良休克指数、修正休克指数、年龄休克指数[(0.6±0.2)、(0.9±0.2)、(0.6±0.2)、(31.7±12.6)]明显小于死亡组[(1.1±0.7)、(1.6±1.0)、(1.1±0.7)、(57.2±42.5)];rSIG明显大于死亡组[(22.5±8.6)vs.(9.3±7.6)],均差异有统计学意义(P<0.05)。rSIG对创伤患者病死率的判断能力最优,患者病死率随rSIG的增大而逐渐降低(Ptrend <0.05)。结论:不同休克指数可较好地评估创伤患者伤情严重程度及预后,在临床上具有一定指导意义,但rSIG用于伤员伤情严重程度及预后评估时准确度更高,同时保持了简易、快速的特点。
Objective:To investigate the value of various shock indexes in assessing the prognosis of trauma patients,and to provide the basis of medical decision-making and treatment guidance for clinicians.Method:The clinical data of trauma patients were collected in the department of emergency from January 2016 to December 2017.The 28-day prognosis was used as the end point,and the patients were divided into the survival group and the death group.The clinical parameters such as the shock index of the two groups were compared,and the relationship between the above indexes and prognosis was analyzed.Patients were divided into<9,9—15,>15groups according to reverse shock index multiplied by Glasgow Coma Scale score(rSIG),and the difference in mortality among the three groups was compared.Result:A total of 1 439 patients were enrolled,including 1 062 males and 377 females.The shock index,modified shock index,adjusted shock index,age shock index in the survival group [(0.6±0.2),(0.9±0.2),(0.6±0.2),(31.7±12.6)]were significantly smaller than the death group[(1.1± 0.7),(1.6±1.0),(1.1±0.7),(57.2±42.5)];rSIG was significantly greater than death group[(22.5±8.6)vs.(9.3±7.6)],the difference was statistically significant(P<0.05).rSIG has the evaluation value to judge the mortality rate of trauma patients.The mortality rate gradually decreased with increasing rSIG(Ptrend<0.05).Conclusion:Various shock indexes can better assess the severity and prognosis of trauma patients,and it has certain guiding significance in clinical.However,rSIG is more accurate in assessing the severity and prognosis of casualties while maintaining a simple and feature applications.
Objective:To investigate the value of various shock indexes in assessing the prognosis of trauma patients,and to provide the basis of medical decision-making and treatment guidance for clinicians.Method:The clinical data of trauma patients were collected in the department of emergency from January 2016 to December 2017.The 28-day prognosis was used as the end point,and the patients were divided into the survival group and the death group.The clinical parameters such as the shock index of the two groups were compared,and the relationship between the above indexes and prognosis was analyzed.Patients were divided into<9,9—15,>15groups according to reverse shock index multiplied by Glasgow Coma Scale score(rSIG),and the difference in mortality among the three groups was compared.Result:A total of 1 439 patients were enrolled,including 1 062 males and 377 females.The shock index,modified shock index,adjusted shock index,age shock index in the survival group [(0.6±0.2),(0.9±0.2),(0.6±0.2),(31.7±12.6)]were significantly smaller than the death group[(1.1± 0.7),(1.6±1.0),(1.1±0.7),(57.2±42.5)];rSIG was significantly greater than death group[(22.5±8.6)vs.(9.3±7.6)],the difference was statistically significant(P<0.05).rSIG has the evaluation value to judge the mortality rate of trauma patients.The mortality rate gradually decreased with increasing rSIG(Ptrend<0.05).Conclusion:Various shock indexes can better assess the severity and prognosis of trauma patients,and it has certain guiding significance in clinical.However,rSIG is more accurate in assessing the severity and prognosis of casualties while maintaining a simple and feature applications.
引文
[1]林健球,谢仁岐.休克指数和体温修正休克指数评估心脏骤停后自主循环恢复患者预后的价值研究[J].临床急诊杂志,2015,16(6):440-442.
[2]李末寒,刘一韡,陆士奇.休克指数在急诊医学研究中的最新进展[J].中国急救医学,2018,38(3):240-245.
[3] Yealy DM,Delbridge TR.The shock index:all that glitters[J].Ann Emerg Med,1994,24(4):714-715.
[4] Mitra B,Fitzgerald M,Chan J.The utility of a shock index≥1as an indication for pre-hospital oxygen carrier administration in major trauma[J].Injury,2014,45(1):61-65.
[5] Liu YC,Liu JH,Fang ZA,et al.Modified shock index and mortality rate of emergency patients[J].World J Emerg Med,2012,3(2):114-117.
[6]胥伶杰,徐军.休克指数在急诊病情判断中的作用[J].临床急诊杂志,2011,12(1):69-71.
[7] Torabi M,Mirafzal A,Rastegari A,et al.Association of triage time Shock Index,Modified Shock Index,and Age Shock Index with mortality in Emergency Severity Index level 2patients[J].Am J Emerg Med,2016,34(1):63-68.
[8] Rady MY,Nightingale P,Little RA,et al.Shock index:a re-evaluation in acute circulatory failure[J].Resuscitation,1992,23(3):227-234.
[9] Pandit V,Rhee P,Hashmi A,et al.Shock index predicts mortality in geriatric trauma patients:an analysis of the National Trauma Data Bank[J].J Trauma Acute Care Surg,2014,76(4):1111-1115.
[10]胥伶杰,徐军,王仲.修正休克指数在急诊病情判断中的作用研究[J].华西医学,2015,30(6):1031-1034.
[11]Smischney NJ,Seisa MO,Heise KJ,et al.Elevated Modified Shock Index Within 24 Hours of ICU Admission Is an Early Indicator of Mortality in the Critically Ill[J].J Intensive Care Med,2018,33(10):582-588.
[12]Terceros-Almanza LJ,Garcia-Fuentes C,BermejoAznarez S,et al.Prediction of massive bleeding.Shock index and modified shock index[J].Med Intensiva,2017,41(9):532-538.
[13]Rau CS,Wu SC,Kuo SC,et al.Prediction of Massive Transfusion in Trauma Patients with Shock Index,Modified Shock Index,and Age Shock Index[J].Int J Environ Res Public Health,2016,13(7):683.
[14]Singh A,Ali S,Agarwal A,et al.Correlation of shock index and modified shock index with the outcome of adult trauma patients:aprospective study of 9860patients[J].N Am J Med Sci,2014,6(9):450-452.
[15]刘元税,宋维,张蕾蕾,等.休克指数和修正休克指数评估心脏骤停自主循环恢复患者的预后[J].中华急诊医学杂志,2014,23(10):1127-1131.
[16]林健球,谢仁岐.休克指数和体温修正休克指数评估心脏骤停后自主循环恢复患者预后的价值研究[J].临床急诊杂志,2015,16(6):440-442.
[17]刘元税,欧阳艳红,张蕾蕾,等.体温修正休克指数与早期预警评分评估急诊内科患者病情严重程度相关性的研究[J].中国急救医学,2015,35(11):1022-1024.
[18]Zarzaur BL,Croce MA,Fischer PE,et al.New vitals after injury:shock index for the young and age x shock index for the old[J].J Surg Res,2008,147(2):229-236.
[19]Kim SY,Hong KJ,Shin SD,et al.Validation of the Shock Index,Modified Shock Index,and Age Shock Index for Predicting Mortality of Geriatric Trauma Patients in Emergency Departments[J].J Korean Med Sci,2016,31(12):2026-2032.
[20]Kimura A,Tanaka N.Reverse shock index multiplied by Glasgow Coma Scale score(rSIG)is a simple measure with high discriminant ability for mortality risk in trauma patients:an analysis of the Japan Trauma Data Bank[J].Crit Care,2018,22(1):87.
[21]Wu SC,Rau CS,Kuo S,et al.The Reverse Shock Index Multiplied by Glasgow Coma Scale Score(rSIG)and Prediction of Mortality Outcome in Adult Trauma Patients:A Cross-Sectional Analysis Based on Registered Trauma Data[J].Int J Environ Res Public Health,2018,15(11).
[2]李末寒,刘一韡,陆士奇.休克指数在急诊医学研究中的最新进展[J].中国急救医学,2018,38(3):240-245.
[3] Yealy DM,Delbridge TR.The shock index:all that glitters[J].Ann Emerg Med,1994,24(4):714-715.
[4] Mitra B,Fitzgerald M,Chan J.The utility of a shock index≥1as an indication for pre-hospital oxygen carrier administration in major trauma[J].Injury,2014,45(1):61-65.
[5] Liu YC,Liu JH,Fang ZA,et al.Modified shock index and mortality rate of emergency patients[J].World J Emerg Med,2012,3(2):114-117.
[6]胥伶杰,徐军.休克指数在急诊病情判断中的作用[J].临床急诊杂志,2011,12(1):69-71.
[7] Torabi M,Mirafzal A,Rastegari A,et al.Association of triage time Shock Index,Modified Shock Index,and Age Shock Index with mortality in Emergency Severity Index level 2patients[J].Am J Emerg Med,2016,34(1):63-68.
[8] Rady MY,Nightingale P,Little RA,et al.Shock index:a re-evaluation in acute circulatory failure[J].Resuscitation,1992,23(3):227-234.
[9] Pandit V,Rhee P,Hashmi A,et al.Shock index predicts mortality in geriatric trauma patients:an analysis of the National Trauma Data Bank[J].J Trauma Acute Care Surg,2014,76(4):1111-1115.
[10]胥伶杰,徐军,王仲.修正休克指数在急诊病情判断中的作用研究[J].华西医学,2015,30(6):1031-1034.
[11]Smischney NJ,Seisa MO,Heise KJ,et al.Elevated Modified Shock Index Within 24 Hours of ICU Admission Is an Early Indicator of Mortality in the Critically Ill[J].J Intensive Care Med,2018,33(10):582-588.
[12]Terceros-Almanza LJ,Garcia-Fuentes C,BermejoAznarez S,et al.Prediction of massive bleeding.Shock index and modified shock index[J].Med Intensiva,2017,41(9):532-538.
[13]Rau CS,Wu SC,Kuo SC,et al.Prediction of Massive Transfusion in Trauma Patients with Shock Index,Modified Shock Index,and Age Shock Index[J].Int J Environ Res Public Health,2016,13(7):683.
[14]Singh A,Ali S,Agarwal A,et al.Correlation of shock index and modified shock index with the outcome of adult trauma patients:aprospective study of 9860patients[J].N Am J Med Sci,2014,6(9):450-452.
[15]刘元税,宋维,张蕾蕾,等.休克指数和修正休克指数评估心脏骤停自主循环恢复患者的预后[J].中华急诊医学杂志,2014,23(10):1127-1131.
[16]林健球,谢仁岐.休克指数和体温修正休克指数评估心脏骤停后自主循环恢复患者预后的价值研究[J].临床急诊杂志,2015,16(6):440-442.
[17]刘元税,欧阳艳红,张蕾蕾,等.体温修正休克指数与早期预警评分评估急诊内科患者病情严重程度相关性的研究[J].中国急救医学,2015,35(11):1022-1024.
[18]Zarzaur BL,Croce MA,Fischer PE,et al.New vitals after injury:shock index for the young and age x shock index for the old[J].J Surg Res,2008,147(2):229-236.
[19]Kim SY,Hong KJ,Shin SD,et al.Validation of the Shock Index,Modified Shock Index,and Age Shock Index for Predicting Mortality of Geriatric Trauma Patients in Emergency Departments[J].J Korean Med Sci,2016,31(12):2026-2032.
[20]Kimura A,Tanaka N.Reverse shock index multiplied by Glasgow Coma Scale score(rSIG)is a simple measure with high discriminant ability for mortality risk in trauma patients:an analysis of the Japan Trauma Data Bank[J].Crit Care,2018,22(1):87.
[21]Wu SC,Rau CS,Kuo S,et al.The Reverse Shock Index Multiplied by Glasgow Coma Scale Score(rSIG)and Prediction of Mortality Outcome in Adult Trauma Patients:A Cross-Sectional Analysis Based on Registered Trauma Data[J].Int J Environ Res Public Health,2018,15(11).