AIS-ISS创伤评分、脑损伤指数对颅脑损伤患者预后自理能力的评估价值
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摘要
目的:探讨AIS-ISS创伤评分与脑损伤指数(craniocerebral injury index,CCII)对颅脑损伤患者出院6个月自理能力的评估价值。方法:回顾性分析132例颅脑损伤患者的临床资料,根据患者出院6个月的远期生活质量评估评分(Karnofsky performance scale,KPS)将患者分为自理能力好组(KPS 51～100分)和自理能力差组(KPS 0～50分),分析患者入院时的AIS-ISS创伤评分和CCII与KPS的相关性,绘制两种评分的受试者工作特征曲线(area under the receiver-operating characteristic curve,ROC),计算曲线下面积,根据敏感度和特异度确定评估标准。结果:入院时的CCII自理能力好组高于自理能力差组,AIS-ISS值自理能力好组低于自理能力差组,差异均有统计学意义(P <0. 05)。CCII与出院6个月KPS呈正相关(r=0. 597,P <0. 01),AIS-ISS创伤评分与出院6个月的KPS呈负相关(r=-0. 627,P <0. 01)。CCII和AIS-ISS创伤评分预测颅脑损伤患者出院6个月KPS的ROC曲线下面积分别为0. 748和0. 802;患者入院时CCII≥2. 5或AIS-ISS创伤评分≤14. 5分时,患者出院6个月的自理能力较好。结论:入院时AIS-ISS创伤评分和CCII对颅脑损伤患者出院6个月KPS均有预测意义,但AIS-ISS创伤评分对患者出院6个月自理能力更具预测价值。
Objective: To discuss value of AIS-ISS trauma score and craniocerebral injury index( CCII) on the self-help ability of patients with craniocerebral injury. Methods: 132 cases of postoperative patients with craniocerebral injury were retrospectively analyzed and divided into good self-care ability group( KPS 51-100) and poor self-care ability group( KPS 0-50) according to Karnofsky performance scale( KPS). The correlation between KPS and CCII,as well as AIS-ISS was analyzed; Area under the receiver-operating characteristic curve( ROC) of the two scoring methods was drawn,the area under curve was calculated,and then evaluating criteria was confirmed based on sensitivity and specificity. Results: CCII of good self-care ability group was higher than that of the poor self-care ability group,AIS-ISS was lower than that of the poor self-care ability group,the difference was statistically significant( P < 0. 05). There was a significant positive correlation between CCII and KPS of 6 months after discharge( r = 0. 597,P < 0. 01),the AIS-ISS was negatively correlated with KPS of 6 months after discharge( r =-0. 627,P < 0. 01). The area of the ROC curve of that CCII and AIS-ISS predicting KPS of 6 months after discharge on patients with craniocerebral injury were respectively 0. 748 and 0. 802; the results showed when CCII was≥2. 5 and AIS-ISS was≤14. 5 on admission,KPS of 6 months after discharge was better. Conclusion: AIS-ISS trauma score and CCII are both predictive for KPS of 6 months after discharge on patients with craniocerebral injury,but AIS-ISS is more closely related to self-care ability and more predictive.
Objective: To discuss value of AIS-ISS trauma score and craniocerebral injury index( CCII) on the self-help ability of patients with craniocerebral injury. Methods: 132 cases of postoperative patients with craniocerebral injury were retrospectively analyzed and divided into good self-care ability group( KPS 51-100) and poor self-care ability group( KPS 0-50) according to Karnofsky performance scale( KPS). The correlation between KPS and CCII,as well as AIS-ISS was analyzed; Area under the receiver-operating characteristic curve( ROC) of the two scoring methods was drawn,the area under curve was calculated,and then evaluating criteria was confirmed based on sensitivity and specificity. Results: CCII of good self-care ability group was higher than that of the poor self-care ability group,AIS-ISS was lower than that of the poor self-care ability group,the difference was statistically significant( P < 0. 05). There was a significant positive correlation between CCII and KPS of 6 months after discharge( r = 0. 597,P < 0. 01),the AIS-ISS was negatively correlated with KPS of 6 months after discharge( r =-0. 627,P < 0. 01). The area of the ROC curve of that CCII and AIS-ISS predicting KPS of 6 months after discharge on patients with craniocerebral injury were respectively 0. 748 and 0. 802; the results showed when CCII was≥2. 5 and AIS-ISS was≤14. 5 on admission,KPS of 6 months after discharge was better. Conclusion: AIS-ISS trauma score and CCII are both predictive for KPS of 6 months after discharge on patients with craniocerebral injury,but AIS-ISS is more closely related to self-care ability and more predictive.
引文
[1]曾小会.重型颅脑损伤患者的预后影响因素探讨[J].基层医学论坛,2018,22(10):1302-1304.
[2]张艺滨,王建群,陈良鑫.脑损伤指数在重型颅脑损伤昏迷患者预后评估中的价值[J].中国临床新医学,2017,10(2):117-120.
[3] MASS A I,HUKKELHOVEN C W,MARSHALL L F,et a1.Prediction of outcome in traumatic brain injury with computed tomographic characteristics:a comparison between the computed tomographic classification and combinations of computed tomographic predictors[J]. Neurosurgery,2005,57(6):1173-1182.
[4]陈维庭.正确掌握和使用创伤评分法(AIS-ISS)[J].创伤外科杂志,2001,3(2):81.
[5]BAMES J,HASSAN A,CUERDEN R,et al. Comparison of injury severity between AIS 2005 and AIS 1990 in 8 large injury database[J]. Ann Adv Automot Med,2009,53:83-89.
[6]WEISS M,BERNOULLI L,ZOLLINGER A. The NACA scale.Construct and predictive validity of the NACA scale for prehospital severity rating in trauma patients[J]. Der Anaesthesist,2001,50(3):150-154.
[7]周际昌.实用肿瘤内科学[M]. 2版.北京:人民卫生出版社,2005:45-48.
[8]饶海承,高卫丰,龚伟,等.不同部位损伤对颅脑外伤患者认知功能的影响[J].东南大学学报(医学版),2014,33(2):137-140.
[9]KIM J J,GEAN A D. Imaging for the diagnosis and management of traumatic brain injury[J]. Neurotherapeutics,2011,8(1):39-53.
[10]BAYIR H,CLARK R S,KOCHANEK P M. Promising strategies to mini-mize secondary brain injury after head trama[J]. Crit Care Med,2003,31(S1):S112-S117.
[11]吴兴明,邹永根,石睿,等.伴有颅脑损伤对骨折患者血清中VEGF和TGF-β1水平影响研究[J].中国实验诊断学,2015,19(1):32-34.
[12]蔺铁,王跃华,罗光东,等.老年中重度颅脑损伤患者CT影像特点及预后的相关性[J].中国老年医学,2014,34(15):4198-4200.
[13]颜琦. AIS-ISS和GCS评分预测颅脑外伤合并多发伤预后比较研究[D].呼和浩特:内蒙古医科大学,2016.
[14]赵威,黄杨,王玉同,等.损伤严重程度评分对重度创伤病情评估的意义与预后相关性研究[J].临床误诊误治,2014,27(1):7-10.
[15]朱勇,孟祥伟,余跃,等.影响颅脑外伤合并多发伤患者预后的危险因素分析[J].海南医学,2015,26(2):239-241.
[16]刘华,李兵,阮海林,等. GCS、ISS、RTS对颅脑损伤合并多发伤患者预后评估的价值[J].山东医药,2015,55(21):4-6.
[2]张艺滨,王建群,陈良鑫.脑损伤指数在重型颅脑损伤昏迷患者预后评估中的价值[J].中国临床新医学,2017,10(2):117-120.
[3] MASS A I,HUKKELHOVEN C W,MARSHALL L F,et a1.Prediction of outcome in traumatic brain injury with computed tomographic characteristics:a comparison between the computed tomographic classification and combinations of computed tomographic predictors[J]. Neurosurgery,2005,57(6):1173-1182.
[4]陈维庭.正确掌握和使用创伤评分法(AIS-ISS)[J].创伤外科杂志,2001,3(2):81.
[5]BAMES J,HASSAN A,CUERDEN R,et al. Comparison of injury severity between AIS 2005 and AIS 1990 in 8 large injury database[J]. Ann Adv Automot Med,2009,53:83-89.
[6]WEISS M,BERNOULLI L,ZOLLINGER A. The NACA scale.Construct and predictive validity of the NACA scale for prehospital severity rating in trauma patients[J]. Der Anaesthesist,2001,50(3):150-154.
[7]周际昌.实用肿瘤内科学[M]. 2版.北京:人民卫生出版社,2005:45-48.
[8]饶海承,高卫丰,龚伟,等.不同部位损伤对颅脑外伤患者认知功能的影响[J].东南大学学报(医学版),2014,33(2):137-140.
[9]KIM J J,GEAN A D. Imaging for the diagnosis and management of traumatic brain injury[J]. Neurotherapeutics,2011,8(1):39-53.
[10]BAYIR H,CLARK R S,KOCHANEK P M. Promising strategies to mini-mize secondary brain injury after head trama[J]. Crit Care Med,2003,31(S1):S112-S117.
[11]吴兴明,邹永根,石睿,等.伴有颅脑损伤对骨折患者血清中VEGF和TGF-β1水平影响研究[J].中国实验诊断学,2015,19(1):32-34.
[12]蔺铁,王跃华,罗光东,等.老年中重度颅脑损伤患者CT影像特点及预后的相关性[J].中国老年医学,2014,34(15):4198-4200.
[13]颜琦. AIS-ISS和GCS评分预测颅脑外伤合并多发伤预后比较研究[D].呼和浩特:内蒙古医科大学,2016.
[14]赵威,黄杨,王玉同,等.损伤严重程度评分对重度创伤病情评估的意义与预后相关性研究[J].临床误诊误治,2014,27(1):7-10.
[15]朱勇,孟祥伟,余跃,等.影响颅脑外伤合并多发伤患者预后的危险因素分析[J].海南医学,2015,26(2):239-241.
[16]刘华,李兵,阮海林,等. GCS、ISS、RTS对颅脑损伤合并多发伤患者预后评估的价值[J].山东医药,2015,55(21):4-6.
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