本文選題：腹部創(chuàng)傷 + 創(chuàng)傷評(píng)分��； 參考：《山西醫(yī)科大學(xué)》2013年碩士論文

【摘要】：目的： 1．了解晉城市近5年腹部創(chuàng)傷患者的年齡構(gòu)成、致傷機(jī)制、損傷臟器構(gòu)成、院內(nèi)救治時(shí)間、救治結(jié)局等情況，從而對(duì)于腹部創(chuàng)傷的發(fā)生原因、規(guī)律以及危險(xiǎn)因素作出全面客觀的認(rèn)識(shí)，進(jìn)而有利于制定和調(diào)整相應(yīng)救治策略及預(yù)防措施，合理分配有限的醫(yī)療資源，規(guī)范救治流程，從根本上提高腹部創(chuàng)傷的救治水平。 2．應(yīng)用本數(shù)據(jù)庫(kù)資料，判斷各評(píng)分系統(tǒng)對(duì)本地區(qū)腹部創(chuàng)傷救治病死率的評(píng)估效果和預(yù)測(cè)價(jià)值，篩選效能較高的創(chuàng)傷評(píng)分預(yù)測(cè)模型及較合理的參數(shù)指標(biāo)。 3.以AIS-2005為解剖評(píng)分基礎(chǔ)，探索建立用于腹部創(chuàng)傷院內(nèi)救治的創(chuàng)傷結(jié)局預(yù)測(cè)模型，并檢驗(yàn)其應(yīng)用效能。 方法： 1.回顧性分析晉煤集團(tuán)總醫(yī)院和所屬六所礦醫(yī)院2008年1月1日——2013年1月31日共5年收治的創(chuàng)傷病例。按照多因素分析樣本量n至少是變量m的5～10倍的基本原則，本研究的最少樣本是100；根據(jù)相關(guān)文獻(xiàn)查詢，腹部創(chuàng)傷患者中生存人數(shù)遠(yuǎn)多于死亡人數(shù)，因本次研究共收集死亡病例數(shù)22人，綜合考慮，本次研究按照死亡：生存=1:4的比例從所有生存患者中隨機(jī)抽取88人進(jìn)行統(tǒng)計(jì)分析，其達(dá)到統(tǒng)計(jì)學(xué)要求的樣本數(shù)量。 2.以生死結(jié)局分組，比較兩組患者入院時(shí)和麻醉前各種生理參數(shù)及各種評(píng)分系統(tǒng)在生死結(jié)局中的異同。生理評(píng)分包括：GCS、T-RTS、RTS、CRAMS；院內(nèi)評(píng)分包括ISS、NISS和以ISS和NISS為基礎(chǔ)計(jì)算的PS。 3.以生死結(jié)局分組，通過(guò)對(duì)患者入院時(shí)及麻醉前各項(xiàng)生理參數(shù)的統(tǒng)計(jì)分析，選取有統(tǒng)計(jì)學(xué)意義的指標(biāo)作為新評(píng)分參數(shù)，并利用Logistic回歸的方法計(jì)算各參數(shù)的權(quán)重系數(shù)，由此得出新評(píng)分方法的數(shù)學(xué)模型。新評(píng)分方法暫命名為腹部創(chuàng)傷記分(revisedtraumascoreofabdomen)記為RTSA。結(jié)合ISS及年齡，將每例患者的RTS和RTSA值代入TRISS公式計(jì)算PS，從而比較并評(píng)價(jià)RTSA和RTS對(duì)腹部創(chuàng)傷患者生死結(jié)局的預(yù)測(cè)效果。 4.腹部創(chuàng)傷新評(píng)分的評(píng)價(jià)：將RTS和RTSA值分別代入TRISS公式計(jì)算PS，通過(guò)兩種模型在預(yù)測(cè)的生／死同實(shí)際生／死的比較，評(píng)價(jià)各自創(chuàng)傷預(yù)測(cè)模型的敏感性、特異性、區(qū)別度、準(zhǔn)確性、死亡誤判率及生存誤判率。 結(jié)果： 1.腹部創(chuàng)傷患者ISS評(píng)分分值越低則其實(shí)際病死率越低，目前爭(zhēng)議的以16亦或以20作為創(chuàng)傷嚴(yán)重度界值，通過(guò)本試驗(yàn)分析未提示有統(tǒng)計(jì)學(xué)意義，其χ2值為0.025，P值為0.874。 2.生理評(píng)分中，存活組GCS、T-RTS、RTS、CRAMS高于死亡組：院內(nèi)評(píng)分中，存活組ISS、NISS小于死亡組；以ISS和NISS為基礎(chǔ)計(jì)算的PS在存活組亦高于死亡組，但兩組預(yù)測(cè)結(jié)果在比較驗(yàn)證傷情效能和預(yù)測(cè)近期死亡的能力差別不大。 3.RTSA模型的非線性回歸方程入院時(shí)RTSA=6.0657G+2.3474S+1.2020M-29.1055麻醉前RTSA=2.3788G+1.9523S+3.1833M-21.9931 4.RTSA模型較既往的TRISS模型，其預(yù)測(cè)結(jié)果的準(zhǔn)確性及特異度變化不大，但顯著提高了生死結(jié)局預(yù)測(cè)的區(qū)別度和敏感性，同時(shí)降低了死亡誤判率。 結(jié)論： 1．本組樣本初步反映了本地區(qū)國(guó)人腹部創(chuàng)傷的流行病學(xué)特點(diǎn)，數(shù)據(jù)資料對(duì)建立國(guó)人MTOS數(shù)據(jù)庫(kù)具有一定價(jià)值。 2．創(chuàng)傷評(píng)分預(yù)測(cè)模型是對(duì)腹部創(chuàng)傷患者損傷嚴(yán)重程度和結(jié)局進(jìn)行評(píng)估的有效方法。通過(guò)本次以腹部損傷為主的資料分析，在實(shí)際存活、死亡組間，各創(chuàng)傷評(píng)分系統(tǒng)的預(yù)測(cè)能力均存在差異，提示創(chuàng)傷評(píng)分有助于準(zhǔn)確、可靠的對(duì)創(chuàng)傷患者進(jìn)行傷情評(píng)估和結(jié)局預(yù)測(cè)。 3．通過(guò)不同創(chuàng)傷評(píng)分預(yù)測(cè)模型的應(yīng)用效果對(duì)比分析，可以篩選出更為合理、科學(xué)的指標(biāo)參數(shù)和效能較高的評(píng)分預(yù)測(cè)模型。 4．根據(jù)本數(shù)據(jù)庫(kù)建立的RTSA模型，更適合本地區(qū)國(guó)人的腹部創(chuàng)傷結(jié)局預(yù)測(cè)，建議在本地區(qū)推廣使用。但RTSA模型在其他地區(qū)的應(yīng)用效果如何，需進(jìn)一步檢驗(yàn)和對(duì)比。
[Abstract]:Objective:
1. understanding of Jincheng city in recent 5 years of abdominal trauma patients age, mechanism of injury, organ damage, hospital treatment time, treatment outcome, and the causes of abdominal trauma, regularity and risk factors make an objective understanding, which is conducive to making appropriate adjustments and treatment strategies and preventive measures. The reasonable distribution of the limited medical resources, standardize the treatment procedure, fundamentally improve the level of treatment of abdominal trauma.
2., we applied the database data to judge the evaluation effect and predictive value of each scoring system on the mortality rate of abdominal trauma treatment in our area, and screened a high effective trauma score prediction model and a reasonable parameter index.
3. based on the anatomical basis of AIS-2005, a prediction model of trauma outcome was established for the treatment of abdominal trauma and its application effectiveness was tested.
Method:
A retrospective analysis of 1. Shanxi coal group general hospital and affiliated hospital in January 1, 2008 six - 31 January 2013, mine 5 years from trauma cases. According to multivariate analysis sample n is at least 5~10 times the basic principle of variable m, at least the research sample is 100; according to Xiang Guanwen Xian query, abdominal trauma patients survival far more than the number of deaths, the study collected the number of deaths of 22 people, a comprehensive consideration, this study according to the death: survival ratio of =1:4 for statistical analysis were randomly selected from all patients living in 88 people, the number of samples reached statistical requirements.
2., according to life and death outcomes, the similarities and differences between two groups of patients in admission and before anesthesia and various scoring systems in life and death outcomes were compared. Physiological scores include GCS, T-RTS, RTS and CRAMS, and hospital scores include ISS, NISS and PS. calculated based on ISS and NISS.
3. death outcome groups, through the statistical analysis of patients before anesthesia and various physiological parameters, selection of the indicators were statistically significant as new scoring parameters, weight coefficient and calculate the parameters by using Logistic regression model, the new scoring method. The number of the new scoring method named abdominal trauma score (revisedtraumascoreofabdomen) RTSA. as the combination of ISS and age, each patient's RTS and RTSA values of TRISS formula PS, to compare and evaluate the prediction effect of RTSA and RTS on abdominal trauma patients between life and death.
Evaluation of 4. new abdominal trauma score: RTS and RTSA respectively by TRISS formula PS, the two models in the prediction of life and death compared with the actual birth / death, evaluated their trauma model sensitivity, specificity, accuracy, degree of differentiation, the death rate of miscarriage of justice and survival rate of misjudgment.
Result:
1., the lower the ISS score of abdominal trauma is, the lower the actual mortality is. The current controversy is 16 or 20 as the boundary value of trauma severity. It is not indicated by this experimental analysis that the chi square value is 0.025, and the P value is 0.874..
2. physiological score, survival group GCS, T-RTS, RTS, CRAMS higher than the death group: hospital score, survival group ISS, less than NISS ISS and NISS in the death group; based on the calculation of the PS in the survival group was also higher than the death group, but the two group forecast results in comparison to verify effectiveness and prediction of recent little injury different abilities of death.
Nonlinear regression equation of 3.RTSA model before RTSA=6.0657G+2.3474S+1.2020M-29.1055 anaesthesia at the time of admission to RTSA=2.3788G+1.9523S+3.1833M-21.9931
Compared with the previous TRISS models, the 4.RTSA model has little change in accuracy and specificity, but significantly improves the difference and sensitivity of prediction of life and death outcomes, and reduces the rate of miscarriage of death.
Conclusion:
1. this group of samples preliminarily reflects the epidemiological characteristics of abdominal trauma in the local people, and the data are of certain value to the establishment of the national MTOS database.
2. trauma score prediction model is a feasible method for patients with abdominal trauma injury severity and outcome evaluation. Through the analysis of the data with abdominal injury, in the actual survival and death group, there were differences in prediction ability of the trauma score system, suggesting that the trauma score contributes to accurate and reliable injury assessment and in predicting the outcome of trauma patients.
3., by comparing and analyzing the application effect of different trauma score prediction models, we can screen out a more reasonable and scientific index parameter and a higher score prediction model.
4. according to the RTSA model established in this database, it is more suitable for the prediction of abdominal trauma outcomes of Chinese people in the region. It is recommended to be popularized in this area. However, the application effect of RTSA model in other areas needs further examination and comparison.

【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R641

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