Index Analysis on Early Prediction of Survival Time in Severe Multiple Trauma Patients_West China Medical Journal

Authors：

 LüLin , HuHai ,  CaoYu

Emergency Department, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

CaoYu, Email: yuyuer@126.com

Keywords：

Severe multiple trauma; Point of care test; Survival time; Early prediction

DOI：

10.7507/1002-0179.201600452

Video：

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Objective To study the value of revised trauma scores (RTS), major trauma outcome study (MTOS)-RTS scores and point of care test (POCT) in the early forecast of survival time in severe multiple trauma patients. Methods Multiple trauma patients treated in the Emergency Department of our hospital between September and December 2015 were included in our study. We collected such data as the basic information on admission, physical signs (breath, blood pressure, state of consciousness) and POCT indexes, including pH value, hemoglobin, base excess, hematocrit value, lactic acid, sodium, anion gap, and blood glucose. We calculated each patient's RTS and MTOS-RTS scores. According to the 30-day prognosis, the patients were divided into survival group and death group. Risk factors for survival time were screened by Cox regression risk model. Results Seventy-five multiple trauma patients were included in our study. Among them, there were 51 males and 24 females. Fourteen of them died. The multivariate analysis in the Cox regression risk model showed that the risk factors for the death of multiple trauma patients included MOTS-RTS score [RR=0.726, 95%CI (0.608, 0.867), P < 0.001) and POCT lactic acid level [RR=1.139, 95%CI (1.010, 1.324), P=0.037]. Conclusion MOTS-RTS combined with lactic acid level may be used in the early forecast of survival time in severe multiple trauma patients.

Citation： LüLin, HuHai, CaoYu. Index Analysis on Early Prediction of Survival Time in Severe Multiple Trauma Patients. West China Medical Journal, 2016, 31(10): 1641-1644. doi: 10.7507/1002-0179.201600452 Copy

1.	胡海, 杜鑫淼, 曹鈺.以休克指數作參數的修正創傷評分在地震現場軀干傷傷員轉運前傷情評估時的應用價值[J].中國急救復蘇與災害醫學雜志, 2015, 10(5): 415-419.
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5.	裴輝, 羅志毅, 劉保池.四種院前創傷評分對急診創傷患者的評估研究[J].中華臨床醫師雜志:電子版, 2011, 5(15): 4394-4400.
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9.	劉朝暉, 吳金春, 廖銀光, 等.多發傷患者血糖水平及血糖變異性與預后的相關性分析[J].中國危重病急救醫學, 2012, 24(11): 643-646.
10.	曹相原, 王曉紅, 馬少林.應激性高血糖癥與胰島素抵抗的相關因素研究[J].中國危重病急救醫學, 2006, 18(12): 751-754.
11.	林毅.損傷嚴重度評分在80例急性多發創傷患者臨床中的應用價值研究[J].黑龍江醫學, 2015, 39(1): 50-51.
12.	林一丹, 楊曉妍, 石應康.修正創傷評分在急診軀干損傷救治中的應用與改良[J].中國胸心血管外科臨床雜志, 2013, 20(2): 181-184.
13.	張紅紅, 溫靜蘭, 陳軍方.修正創傷評分在多發傷患者急救中的應用[J].現代臨床護理, 2015, 14(6): 37-40.
14.	Moore L, Lavoie A, Lesage N, et al. Statistical validation of the Revised Trauma Score[J]. J Trauma, 2006, 60(2): 305-311.
15.	陳罡, 葉文玲, 秦巖, 等.代償性酸中毒、炎性反應和病因是影響急性腎損傷預后的重要因素[J].基礎醫學與臨床, 2015, 35(5): 648-653.
16.	于欣, 王瀟然, 劉月英, 等.血pH值和乳酸水平判斷心肺復蘇患者預后的臨床價值[J].中國老年學雜志, 2013, 33(24): 6123-6124.
17.	何朝暉, 支興剛.創傷性腦損傷后高血糖的發生機制及對預后的影響[J].創傷外科雜志, 2004, 6(2): 149-151.
18.	Monnier L, Colette C. Glycemic variability: should we and can we prevent it? [J]. Diabetes Care, 2008, 31(Suppl 2): S150-S154.
19.	Montmany Vioque S, Navarro Soto S, Rebasa Cladera P, et al. Measurement of lacticacid in multiple injury patients and its usefulness as a predictor of multiorgan failure andmortality[J]. Cir Esp, 2012, 90(2): 107-113.
20.	Guyette F, Suffoletto B, Castillo JL, et al. Prehospital serum lactate as a predictor of outcomes in trauma patients: a retrospective observational study[J]. Trauma, 2011, 70(4): 782-786.

1. 胡海, 杜鑫淼, 曹鈺.以休克指數作參數的修正創傷評分在地震現場軀干傷傷員轉運前傷情評估時的應用價值[J].中國急救復蘇與災害醫學雜志, 2015, 10(5): 415-419.
2. 張連陽.重視多發傷的精確傷情評估[J].重慶醫學, 2010, 39(9): 1025-1026.
3. 曲紀富, 文亮, 劉明華, 等.嚴重多發傷伴創傷性休克的診治分析[J].中國急救醫學, 2009, 29(5): 401-404.
4. Sloan EP, Koenigsberg M, Clark JM, et al. The use of the Revised Trauma Score as an entry criterion in traumatic hemorrhagic shock studies: data from the DCLHb clinical trials[J]. Prehosp Disaster Med, 2012, 27(4): 330-344.
5. 裴輝, 羅志毅, 劉保池.四種院前創傷評分對急診創傷患者的評估研究[J].中華臨床醫師雜志:電子版, 2011, 5(15): 4394-4400.
6. 裴輝, 劉保池.我國院前創傷評分系統的應用現狀及展望[J].世界急危重病醫學雜志, 2007, 4(5): 2079-2085.
7. 梁連生, 張建平. APACHEⅡ評分與血乳酸水平對ICU多發傷患者預后的評估應用[J].內蒙古醫學雜志, 2013, 45(10): 1189-1191.
8. 王昊, 吳大瑋, 陳曉梅, 等.血乳酸水平及清除率和升高時間與重癥監護病房危重患者預后的關系[J].中國危重病急救醫學, 2009, 21(6): 357-360.
9. 劉朝暉, 吳金春, 廖銀光, 等.多發傷患者血糖水平及血糖變異性與預后的相關性分析[J].中國危重病急救醫學, 2012, 24(11): 643-646.
10. 曹相原, 王曉紅, 馬少林.應激性高血糖癥與胰島素抵抗的相關因素研究[J].中國危重病急救醫學, 2006, 18(12): 751-754.
11. 林毅.損傷嚴重度評分在80例急性多發創傷患者臨床中的應用價值研究[J].黑龍江醫學, 2015, 39(1): 50-51.
12. 林一丹, 楊曉妍, 石應康.修正創傷評分在急診軀干損傷救治中的應用與改良[J].中國胸心血管外科臨床雜志, 2013, 20(2): 181-184.
13. 張紅紅, 溫靜蘭, 陳軍方.修正創傷評分在多發傷患者急救中的應用[J].現代臨床護理, 2015, 14(6): 37-40.
14. Moore L, Lavoie A, Lesage N, et al. Statistical validation of the Revised Trauma Score[J]. J Trauma, 2006, 60(2): 305-311.
15. 陳罡, 葉文玲, 秦巖, 等.代償性酸中毒、炎性反應和病因是影響急性腎損傷預后的重要因素[J].基礎醫學與臨床, 2015, 35(5): 648-653.
16. 于欣, 王瀟然, 劉月英, 等.血pH值和乳酸水平判斷心肺復蘇患者預后的臨床價值[J].中國老年學雜志, 2013, 33(24): 6123-6124.
17. 何朝暉, 支興剛.創傷性腦損傷后高血糖的發生機制及對預后的影響[J].創傷外科雜志, 2004, 6(2): 149-151.
18. Monnier L, Colette C. Glycemic variability: should we and can we prevent it? [J]. Diabetes Care, 2008, 31(Suppl 2): S150-S154.
19. Montmany Vioque S, Navarro Soto S, Rebasa Cladera P, et al. Measurement of lacticacid in multiple injury patients and its usefulness as a predictor of multiorgan failure andmortality[J]. Cir Esp, 2012, 90(2): 107-113.
20. Guyette F, Suffoletto B, Castillo JL, et al. Prehospital serum lactate as a predictor of outcomes in trauma patients: a retrospective observational study[J]. Trauma, 2011, 70(4): 782-786.

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