【摘要】 目的探讨rSIG(the reverse shock index multiplied by Glasgow coma scale score)指数与D-二聚体水平预测多发伤患者预后的价值。方法回顾性分析福建省立医院急诊抢救室在2019年11月至2020年8月期间收治141例多发伤患者的临床资料,根据患者受伤后28d时的生存情况,分成存活组(122例)和死亡组(19例)。使用SPSS 26.0软件分析组间的血液检验结果、rSIG指数、D-二聚体水平差异,分析rSIG指数与D-二聚体水平的关系等。通过绘制受试者操作特征曲线(receiver operator characteristic curve,ROC curve,ROC曲线),分析rSIG指数与D-二聚体水平及两者联合在判断多发伤患者预后的预测价值。根据ROC曲线分析的最佳截断值,将患者分为rSIG指数≤7.75组(21例)和rSIG指数>7.75组(120例),D-二聚体水平≤20.6mg/L组(103例)和D-二聚体水平>20.6mg/L组(38例),比较各组间28d死亡率。结果总共纳入141例患者。存活组的rSIG指数(18.1±7.8)大于死亡组(15.5±10.6),但差异无统计学意义(t=﹣1.243,P=0.216),存活组D-二聚体水平(11.3±10.2)mg/L低于死亡组的(26.4±10.4)mg/L,差异有统计学意义(t=﹣4.750,P<0.05)。D-二聚体水平ROC曲线下面积(area under the curve,AUC)大于rSIG指数(0.849比0.588),差异具有统计学意义(Z=2.527,P<0.05);D-二聚体水平AUC也大于rSIG指数与D-二聚体水平联合(0.849比0.846),但差异无统计学意义(Z=0.158,P=0.875);rSIG指数与D-二聚体水平联合AUC大于rSIG指数(0.846比0.588),差异有统计学意义(Z=2.760,P<0.05)。rSIG指数≤7.75组患者的28d死亡率(33.3%)大于rSIG指数>7.75组(10.0%),差异有统计学意义(χ~2=8.346,P<0.05)。D-二聚体水平≤20.6mg/L组28d死亡率(3.9%)小于D-二聚体水平>20.6mg/L组(39.5%),差异有统计学意义(χ~2=30.157,P<0.05)。rSIG指数同D-二聚体水平呈负相关(r=﹣0.046),但差异无统计学意义(P=0.592)。结论 rSIG指数、D-二聚体水平对多发伤患者的预后有预测价值(AUC均>0.5),其中D-二聚体预测能力优于rSIG指数及二者联合,在临床指导多发伤患者救治有一定的参考意义。更多还原

【Abstract】 Objective To investigate the evaluation value of the reverse shock index multiplied by Glasgow Coma Scale score (rSIG) and D-dimer in the prognosis of patients with multiple trauma.Method The clinical data of 141 patients with multiple trauma admitted to the emergency room of Fujian Provincial Hospital from November 2019 to August 2020 were retrospectively analyzed.According to the treatment outcome on day 28 after injury,the patients were divided into survival group (122 cases) and death group (19 cases).The blood test indexes,rSIG,serum D-dimer level and other indexes between groups were compared by SPSS 26.0 software,and the relationship between rSIG and D-dimer were analyzed.Receiver operating characteristic (ROC) curve analysis was performed to analyze the predictive value of rSIG and D-dimer and the combination of the two on the prognosis of patients with multiple trauma.According to the optimal cut-off value,patients were divided into rSIG≤7.75 group (21 cases) and rSIG>7.75 group (120 cases),D-dimer≤20.6mg/L group (103 cases) and D-dimer > 20.6mg/L group (38 cases).The differences in mortality day 28 among the groups was compared.Result One hundred and forty-one patients were included.The rSIG of the survival group was higher than that of the death group[(18.1±7.8) vs (15.5±10.6),t=﹣1.243,P=0.216].D-dimer level of the survival group was lower than that of the death group[(11.3±10.2) vs (26.4±10.4),t=﹣4.750,P<0.05].D-dimer was superior to rSIG in evaluating the prognosis of patients with multiple trauma,and the difference was statistically significant (Z=2.527,P<0.05).D-dimer was also superior to rSIG in combination with D-dimer,but the difference was not statistically significant (Z=0.158,P=0.875).rSIG in combination with D-dimer was superior than rSIG,and the difference was statistically significant (Z=2.760,P<0.05).The mortality rate on day 28 in the rSIG≤7.75 group was greater than that in the rSIG >7.75 group (χ~2=8.346,P<0.05).The mortality on day 28 of the D-dimer ≤ 20.6 mg/L group was lower than that of the D-dimer> 20.6 mg/L group (χ~2=30.157,P<0.05).The relationship between the patient’s rSIG and D-dimer was negative (r=﹣0.046),but the difference was not statistically significant (P=0.592).Conclusion The rSIG and D-dimer have good predictive value for the prognosis of patients with multiple trauma.更多还原