目的:探討使用院前指數(shù)(Prehospital Index, PHI)及格拉斯哥昏迷評(píng)分(Glasgow Coma Score, GCS)兩種創(chuàng)傷評(píng)分法對(duì)院前急救中急性酒精中毒合并外傷性顱內(nèi)出血患者的評(píng)估價(jià)值。方法: 納入68例院前急救中酒精中毒合并頭外傷患者,院前均進(jìn)行PHI及GCS兩種創(chuàng)傷評(píng)分,隨訪至出院,以頭部CT掃描及隨訪結(jié)果作為標(biāo)準(zhǔn)以判斷患者是否伴有顱內(nèi)出血。計(jì)算兩種創(chuàng)傷評(píng)分的敏感度、特異度、陽(yáng)性似然比、陰性似然比、陽(yáng)性預(yù)測(cè)值、陰性預(yù)測(cè)值及Youden指數(shù),并作出受試者工作特征曲線(ROC曲線),以正態(tài)離差值Z檢驗(yàn)兩種評(píng)分法ROC曲線下面積的差異。 結(jié)果: 院前指數(shù)以6分作為診斷界值,敏感度為94.7%,特異度為71.4%;格拉斯哥昏迷評(píng)分以9分作為診斷界值,敏感度為98.8%,特異度為30.6%,PHI及GCS的ROC曲線下面積分別是0.881和0.678,其差異有統(tǒng)計(jì)學(xué)意義。結(jié)論: 在對(duì)急性酒精中毒合并頭外傷患者是否伴有顱內(nèi)出血的院前評(píng)估中,院前指數(shù)較格拉斯哥昏迷評(píng)分更有價(jià)值。
引用本文: 胡海,杜鑫淼,蔣臻,許樹(shù)耘,曹鈺. 院前急救中兩種創(chuàng)傷評(píng)分法對(duì)急性酒精中毒合并外傷性顱內(nèi)出血患者的評(píng)估作用. 華西醫(yī)學(xué), 2009, 24(8): 1929-1930. doi: 復(fù)制
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- 1. 馮麗潔,沈洪.防御酒精中毒減少意外傷害[J].中華急診醫(yī)學(xué)雜志,2002,11(4):277-278.
- 2. 李增法,張衍,孫世遠(yuǎn).酒醉后顱腦外傷救治分析[J].中國(guó)急救醫(yī)學(xué),2000,20(4):250.
- 3. 石應(yīng)康主編.急診手冊(cè)[M].北京:人民衛(wèi)生出版社,2000:160.
- 4. GRMEC S,GASPAROVIC V. Comparison of APACHE II, MEES and Glasgow Coma Scale in patients with nontraumatic coma for prediction of mortality[J]. Crit Care, 2001, 5(1): 19-23.
- 5. MALANGONI MA. Alcohol Interventions for Trauma Patients Treated in Emergency Departments: Can We Afford Not to Intervene?[J] Ann Surg, 2005,241(4): 551-552.
- 6. GENTILELLO LM, EBEL BE, WICKIZER TM,et al. Alcohol Interventions for Trauma Patients Treated in Emergency Departments and Hospitals: A Cost Benefit Analysis[J]. Ann Surg, 2005,241(4): 541-550.
- 7. 崔新民,冉住國(guó),易代碧,等.重型顱腦損傷的院前急救[J]. 中華急診醫(yī)學(xué)雜志,2004,13(1):63.
- 8. 戴艷,蔡惠芳.酒醉后顱腦損傷的急救護(hù)理體會(huì)[J].現(xiàn)代中西醫(yī)結(jié)合雜志,2004,13(13):1784.
- 9. 胡文賢,徐相瑞,王志國(guó).急性創(chuàng)傷的分類與院前急救[J]. 中華急診醫(yī)學(xué)雜志,2004,13(4):284-285.
- 10. WILLIAMS RJ, HITTINGER R, GLAZER G,et al. Resource implications of head injuries on an acute surgical unit[J]. J R Soc Med, 1994, 87(2): 83-86.
- 11. 龔洪福,何明方,梁興澤,等. 急性酒精中毒合并顱腦外傷的診治體會(huì)[J].創(chuàng)傷外科雜志,2005,7(1):62.