1、胸部创伤肋骨骨折评分和肋骨评分对创伤性肋骨骨折患者伤情的评估价值及对不良预后事件的预测效能研究靳 贺1,危朝辉1,张 琦1,孙俊峰1,杨宝升1,罗世兰2,曹 芳1,刘国栋31.解放军联勤保障部队第九二六医院心胸外科,云南 开远 661600;2.解放军联勤保障部队第九二六医院烧伤整形外科,云南 开远 661600;3.陆军军医大学大坪医院战创伤医学中心,重庆 400042【基金项目】科技强院专项科研计划(926YY22XK07)【通信作者】刘国栋,E-mail:frankliugd 【摘要】目的 探讨肋骨骨折评分(rib fracture score,RFS)与肋骨评分(rib score,R
2、S)对创伤性肋骨骨折患者的伤情评估价值及对不良预后事件的预测效能。方法 回顾性分析 2020 年 1 月2021 年 12 月解放军联勤保障部队第九二六医院心胸外科收治创伤性肋骨骨折患者 137 例,男性 93 例,女性 44 例;年龄 1383 岁,平均 50.2 岁。RFS 和 RS 为两种用于创伤性肋骨骨折患者伤情评估及预后预测的评分。依据患者是否存在肺挫伤分为肺挫伤组(82 例)和无肺挫伤组(55 例)。采用 Wilcoxon 秩和检验比较发生肺部感染、呼吸衰竭以及呼吸不良事件患者与未发生以上情况患者的 RFS 和 RS 分值差异,分析两种评分对患者伤情的评估价值。运用受试者工作特征(
3、receiver operating characteristic,ROC)曲线及曲线下面积(area under the curve,AUC)分析两种评分对发生肺部感染、呼吸衰竭的预测效能。结果 伤情评估方面,全部患者中发生呼吸不良事件、肺部感染与呼吸衰竭患者 RFS 分值12(7,18)、12(7,18)和 13(8,19)及 RS 分值2(1,4)、3(1,4)和 2(2,4)均较未发生呼吸不良事件、未发生肺部感染与未发生呼吸衰竭患者高RFS 分值:5(3,9)、7(4,11)和 6(3,11);RS 分值:0(0,2)、1(0,2)和 1(0,2),差异有统计学意义(P0.05)。不良
4、预后事件预测方面,全部患者应用 RS 预测呼吸不良事件、肺部感染及呼吸衰竭时的 AUC 分别为 0.776、0.753、0.768,均大于应用 RFS 的患者(0.742、0.695、0.765)。肺挫伤组预测呼吸不良事件及肺部感染方面,应用RS 时的 AUC(0.719、0.694)大于应用 RFS(0.677、0.634),预测呼吸衰竭方面,应用 RFS 时 AUC(0.728)大于应用 RS(0.722)。无肺挫伤组,预测呼吸不良事件及肺部感染方面,应用 RFS 时的 AUC(0.816、0.818)大于应用 RS(0.772、0.721),预测呼吸衰竭方面,应用 RS 时的 AUC(0
5、.794)大于应用 RFS(0.767)。结论RFS 和 RS 可用于创伤性肋骨骨折患者的伤情评估,伴有肺挫伤患者中,RS 对呼吸不良事件及肺部感染的预测效能更优,RFS 对呼吸衰竭的预测效能更优;无肺挫伤患者中,RFS 对呼吸不良事件及肺部感染的预测效能更优,RS 对呼吸衰竭的预测效能更优。【关键词】肋骨骨折;创伤评分;伤情评估;不良事件;预测【中图分类号】R 655.1 【文献标识码】A 【DOI】10.3969/j.issn.1009-4237.2023.06.008Rib fracture score and rib score for evaluating injury severi
6、ty and predicting adverse events in patients with traumatic rib fracturesJin He1,Wei Chaohui1,Zhang Qi1,Sun Junfeng1,Yang Baosheng1,Luo Shilan2,Cao Fang1,Liu Guodong31.Department of Cardiothoracic Surgery,926th Hospital of PLA Joint Logistics Support Force,Kaiyuan,Yunnan 661600,China;2.Department of
7、 Burns and Plastic Surgery,926th Hospital of PLA Joint Logistics Support Force,Kaiyuan,Yunnan 661600,China;3.War Trauma Medical Center,Daping Hospital,Army Medical University,Chongqing 400042,China【Abstract】Objective To investigate the value of rib fracture score(RFS)and rib score(RS)for evaluating
8、injury severity and predicting adverse events in patients with traumatic rib fractures.MethodsClinical data of 137 patients with traumatic rib fractures admitted to the Department of Cardiothoracic Surgery of 926th Hospital of PLA Joint Logistics Support Force from Jan.2020 to Dec.2021 were retrospe
9、ctively analyzed.There were 93 male and 44 female aged 13-83 years,mean 50.2 years.RFS and RS,two scoring systems for injury evaluation and prognosis prediction in patients with traumatic rib fractures,were calculated for all the patients enrolled.Patients were divided into two groups accord-ing to
10、the presence or absence of pulmonary contusion,respectively pulmonary contusion group(n=82)and non-pul-734创伤外科杂志 2023 年第 25 卷第 6 期 J Trauma Surg,2023,Vol.25,No.6monary contusion group(n=55).RFS and RS were compared between patients with or without pneumonia,respiratory failure and respiratory advers
11、e events by Wilcoxon rank sum test,so as to analyze the value of RFS and RS in injury e-valuation.Receiver operating characteristic(ROC)curve and area under the curve(AUC)were used to analyze the predictive efficacy of RFS and RS for incidence of pneumonia,respiratory failure and respiratory adverse
12、 events.Results In terms of injury evaluation,the patients with respiratory adverse events,pneumonia and respiratory failure showed a significantly higher RFS12(7,18),12(7,18)and 13(8,19)and RS 2(1,4),3(1,4)and 2(2,4)than those without RFS:5(3,9),7(4,11)and 6(3,11);RS:0(0,2),1(0,2)and 1(0,2)(all P0.
13、05).For all the patients,the AUC of RS in predicting respiratory adverse events,pneumonia and respiratory failure was 0.776,0.753 and 0.768,respectively,higher than that of RFS(0.742,0.695 and 0.765).In pulmonary contu-sion group,the AUC of RS(0.719 and 0.694)was greater than that of RFS(0.677 and 0
14、.634)in predicting respira-tory adverse events and pneumonia,but smaller in predicting respiratory failure(0.722 vs.0.728).In non-pulmonary contusion group,the results were different:RFS showed a higher AUC(0.816 and 0.818)than RS(0.772 and 0.721)in predicting respiratory adverse events and pneumoni
15、a,but a lower value in predicting respiratory failure(0.767 vs.0.794).Conclusion RFS and RS can be used for injury severity evaluation in patients with traumatic rib fractures.For those with pulmonary contusion,RS is superior in predicting respiratory adverse events and pneumo-nia,and RFS superior i
16、n predicting respiratory failure.In patients without pulmonary contusion,RFS is superior in predicting respiratory adverse events and pneumonia,and RS superior in predicting respiratory failure.【Key words】Rib fractures;Trauma scoring;Injury evaluation;Adverse events;Prediction 肋骨骨折是胸部创伤中最常见的损伤1。我国每年肋骨骨折患者人数 150200 万2。肋骨骨折所导致的胸痛可使胸壁肌肉痉挛,呼吸变浅,咳嗽无力,呼吸道分泌物增多、潴留,易致肺通气障碍、肺不张和肺部感染3。如能早期识别高危患者并对其采取有效的干预措施,则可改善患者的结局4。创伤评分是通过记分的形式对创伤患者的损伤程度和结局等属性进行定量或半定量记录以描述和评估创伤特征和属性的方法,不仅用于标准化评定损伤严重程度,而且广泛应用于创伤患者的预后判断及