2024 年第 10 期 第 19 卷

反向休克指数和格拉斯哥昏迷量表评分的乘积指数联合血清指标对多发伤合并多器官功能障碍综合征患者预后的预测价值分析

Analysis of the predictive value of the product index of reverse shock index and Glasgow coma scale score combined with serum indicators for the prognosis of patients with multiple trauma combined with multiple organ dysfunction syndrome

作者：张明1张宏颖2杨秋兰2张霞3黄开飞4

英文作者：Zhang Ming1 Zhang Hongying2 Yang Qiulan2 Zhang Xia3 Huang Kaifei4

单位：1华北理工大学附属医院急诊科，唐山063000；2河北省唐山中心医院神经外科，唐山063000；3华北理工大学，唐山063210；4河北省石家庄长城中西医结合医院外科，石家庄050000

英文单位：1Department of Emergency North China University of Science and Technology Affiliated Hospital Tangshan 063000 China; 2Department of Neurosurgery Tangshan Central Hospital Hebei Province Tangshan 063000 China; 3North China University of Science and Technology Tangshan 063210 China; 4Department of Surgery Shijiazhuang Changcheng Hospital of Integrated Traditional Chinese and Western Medicine Hebei Province Shijiazhuang 050000 China

关键词：多发伤；多器官功能障碍综合征；反向休克指数和格拉斯哥昏迷量表评分的乘积指数；D-二聚体；纤维蛋白原；C反应蛋白；预后

英文关键词：Multipletrauma;Multipleorgandysfunctionsyndrome;TheproductindexofreverseshockindexandGlasgowcomascalescore;D-dimer;Fibrinogen;C-reactiveprotein;Prognosis

• 摘要：

• 目的 探讨反向休克指数和格拉斯哥昏迷量表评分的乘积(rSIG)指数联合血清D-二聚体、纤维蛋白原、C反应蛋白对多发伤合并多器官功能障碍综合征（MODS）患者预后的预测价值。方法 选取2020年1月至2022年1月在华北理工大学附属医院急诊抢救室治疗的194例多发伤患者作为研究对象。根据治疗过程中有无发生MODS将其分为无MODS组（98例）和MODS组（96例）；MODS组再根据患者受伤后28 d时的生存情况分为存活组（52例）和死亡组（44例）。比较各组血清D-二聚体、纤维蛋白原、C反应蛋白水平以及rSIG指数；多因素Logistic回归方法分析多发伤合并MODS患者预后的影响因素；受试者工作特征（ROC）曲线分析rSIG指数联合血清D-二聚体、纤维蛋白原、C反应蛋白对多发伤合并MODS患者预后的预测价值。结果  MODS组血清D-二聚体、纤维蛋白原、C反应蛋白水平高于无MODS组［（14±3）mg/L比（9±3）mg/L、（4.5±1.0）g/L比（3.0±1.0）g/L、（32±6）mg/L比（21±6）mg/L］，差异均有统计学意义（t=10.352、10.079、12.883，均P<0.001）。死亡组多发伤合并MODS患者血清D-二聚体、纤维蛋白原、C反应蛋白水平显著高于存活组，rSIG指数显著低于存活组（均P<0.001）。多因素Logistic回归分析结果显示D-二聚体、纤维蛋白原、C反应蛋白、rSIG指数是多发伤合并MODS患者预后的独立影响因素（均P<0.05）。ROC曲线分析结果显示D-二聚体、纤维蛋白原、C反应蛋白、rSIG指数联合检测预测多发伤合并MODS患者预后的曲线下面积为0.964，敏感度为84.09%，特异度为96.15%，优于各指标单独预测（均P<0.05）。结论 多发伤合并MODS死亡组患者血清D-二聚体、纤维蛋白原、C反应蛋白显著上升，rSIG指数显著下降，以上指标联合对多发伤合并MODS患者的预后具有较好的预测价值。

• Objective To investigate the prognostic value of the product of reverse shock index and Glasgow coma scale (rSIG) index combined with serum D-dimer, fibrinogen and C-reactive protein in multiple trauma patients with multiple organ dysfunction syndrome (MODS). Methods A total of 194 patients with multiple trauma treated in the Emergency Treatment Room, North China University of Science and Technology Affiliated Hospital from January 2020 to January 2022 were selected as the research objects. According to the presence or absence of MODS during treatment, they were divided into non-MODS group (98 cases) and MODS group (96 cases). The MODS group was further divided into survival group (52 cases) and death group (44 cases) according to the survival situation of patients at 28 d after injury. The levels of serum D-dimer, fibrinogen, C-reactive protein and rSIG index were compared among the groups. Multivariate Logistic regression was used to analyze the influencing factors of the prognosis of multiple trauma patients with MODS. Receiver operating characteristic (ROC) curve was used to analyze the value of rSIG index combined with serum D-dimer, fibrinogen and C-reactive protein in predicting the prognosis of multiple trauma patients with MODS. Results The levels of serum D-dimer, fibrinogen and C-reactive protein in MODS group were higher than those in non-MODS group ［（14±3）mg/L vs （9±3）mg/L,（4.5±1.0）g/L vs （3.0±1.0）g/L, （32±6）mg/L vs （21±6）mg/L］（t=10.352,10.079,12.883; all P<0.001）. The levels of serum D-dimer, fibrinogen, and C-reactive protein in the death group were significantly higher than those in the survival group, and the rSIG index was significantly lower than that in the survival group (all P<0.001). Multivariate Logistic regression analysis showed that D-dimer, fibrinogen, C-reactive protein and rSIG index were independent prognostic factors for multiple trauma patients with MODS (all P<0.05). ROC curve analysis showed that the area under the curve of D-dimer, fibrinogen, C-reactive protein, and rSIG index combined detection to predict the prognosis of multiple trauma patients with MODS was 0.964, the sensitivity was 84.09%, and the specificity was 96.15%, which was better than that of each index alone (all P<0.05). Conclusion The serum D-dimer, fibrinogen, and C-reactive protein of patients in the death group of multiple trauma combined with MODS increased significantly, and the rSIG index decreased significantly. The combination of the above indicators has a good predictive value for the prognosis of patients with multiple trauma combined with MODS.