摘要
目的探讨严重创伤患者并发急性呼吸窘迫综合征(ARDS)的相关因素,并构建列线图预测模型。方法回顾性选取2023年3月至2025年3月厦门医学院附属第二医院收治的严重创伤患者212例,根据是否发生ARDS分为ARDS组(83例)和非ARDS组(129例)。比较两组一般资料、既往病史、损伤特征、救治情况、实验室检查指标,采用多因素Logistic回归分析严重创伤患者发生ARDS的独立危险因素,并以此构建列线图预测模型,绘制ROC曲线分析列线图预测模型预测严重创伤患者发生ARDS的价值。结果ARDS组创伤严重程度评分≥25分、肺挫伤、连枷胸、入院低氧血症、休克时间≥4 h、剖腹探查、胃内容物误吸、肺部感染、胸部简明损伤分级评分、入院24 h血清肿瘤坏死因子α水平高于非ARDS组(P<0.05)。多因素Logistic回归分析显示,创伤严重程度评分≥25分、胸部简明损伤分级评分高、有肺挫伤、低氧血症、休克持续时间≥4 h及入院24 h肿瘤坏死因子α水平高是严重创伤患者发生ARDS的独立危险因素(OR=2.705,95%CI:1.631~4.485,P<0.01;OR=3.800,95%CI:2.310~6.252,P<0.01;OR=5.270,95%CI:3.038~9.141,P<0.01;OR=4.158,95%CI:2.483~6.962,P<0.01;OR=3.187,95%CI:2.058~4.934,P<0.01;OR=2.389,95%CI:1.433~3.985,P<0.01)。ROC曲线分析显示,列线图预测模型预测严重创伤患者发生ARDS的AUC为0.914,敏感度为78.31%,特异度为93.80%。结论创伤严重程度评分≥25分、胸部简明损伤分级评分高、有肺挫伤、低氧血症、休克持续时间≥4 h及入院24 h肿瘤坏死因子α水平高是严重创伤患者发生ARDS的独立危险因素,以这些风险因素构建的列线图预测模型是预测严重创伤患者ARDS发生的有效工具。
Objective To explore the related factors of acute respiratory distress syndrome(ARDS)in patients with severe trauma and to construct a nomogram prediction model.Methods A total of 212 patients with severe trauma admitted to The Second Afffliated Hospital of Xiamen Medical College from March 2023 to March 2025 were retrospectively selected.According to the occurrence of ARDS,they were divided into an ARDS group(83 cases)and a non-ARDS group(129 cases).General data,past medical history,injury characteristics,treatment conditions,and laboratory indicators were compared between the two groups.Multivariate Logistic regression analysis was used to identify independent risk factors for ARDS in severe trauma patients,and a nomogram prediction model was constructed based on these factors.The ROC curve was plotted to analyze the value of the nomogram prediction model in predicting ARDS in severe trauma patients.Results The ARDS group had higher proportions of Injury Severity Score≥25,pulmonary contusion,ffail chest,admission hypoxemia,shock time≥4 h,laparotomy,aspiration of gastric contents,pulmonary infection,higher Abbreviated Injury Scale chest score,and higher serum tumor necrosis factor-αlevel at 24 h after admission compared to the non-ARDS group(P<0.05).Multivariate Logistic regression analysis showed that Injury Severity Score≥25,high Abbreviated Injury Scale chest score,pulmonary contusion,hypoxemia at admission,shock duration≥4 h,and high tumor necrosis factor-αlevel at 24 h after admission were independent risk factors for ARDS in severe trauma patients(OR=2.705,95%CI:1.631–4.485,P<0.01;OR=3.800,95%CI:2.310–6.252,P<0.01;OR=5.270,95%CI:3.038–9.141,P<0.01;OR=4.158,95%CI:2.483–6.962,P<0.01;OR=3.187,95%CI:2.058–4.934,P<0.01;OR=2.389,95%CI:1.433–3.985,P<0.01).ROC curve analysis showed that the nomogram prediction model had an AUC of 0.914,a sensitivity of 78.31%,and a speciffcity of 93.80%for predicting ARDS in severe trauma patients.Conclusion Injury Severity Score≥25,high Abbreviated Injury Scale chest score,pulmonary contusion,hypoxemia at admission,shock duration≥4 h,and high tumor necrosis factor-αlevel at 24 h after admission are independent risk factors for ARDS in severe trauma patients.The nomogram prediction model constructed based on these risk factors is an effective tool for predicting the occurrence of ARDS in severe trauma patients.
作者
江小香
林海蓉
何飞
付水芹
陈阿真
JIANG Xiaoxiang;LIN Hairong;HE Fei;FU Shuiqin;CHEN A'zhen(Department of Critical Care Medicine,The Second Afffliated Hospital of Xiamen Medical College,Xiamen,Fujian 361021,China;Department of Hepatobiliary Surgery,The Second Affiliated Hospital of Xiamen Medical College,Xiamen,Fujian 361021,China)
出处
《转化医学杂志》
2026年第1期30-35,共6页
Translational Medicine Journal
基金
2022年度福建省中青年教师教育科研项目(JAT220411)
厦门市护理学会科研课题项目(XMSHLXH2318)。
