• 中国科学论文统计源期刊
  • 中国科技核心期刊
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  • 日本科学技术振兴机构数据库(JST)
临床输血与检验

临床输血与检验 ›› 2019, Vol. 21 ›› Issue (4): 359-363.DOI: 10.3969/j.issn.1671-2587.2019.04.007

• 临床输血 • 上一篇    下一篇

探讨初始下腔静脉直径预测钝性创伤患者大量输血需求的价值

伍羿, 王德宇, 赵祥庚   

  1. 570208 中南大学附属海口市人民医院急诊外科
  • 收稿日期:2019-07-01 出版日期:2019-08-20 发布日期:2019-08-28
  • 作者简介:伍羿（1982-）,男,主治医师,硕士,主要从事急诊外科工作,（Tel）13700484391（E-mail）xiongdi1999@163.com。
  • 基金资助:
    *本课题受2017年海南省卫生计生行业科研项目（No.16A200043）资助

Prediction of The Inferior Vena Cava Diameter for The Requirements of Massive Transfusion in Patients with The Vein Blunt Trauma

Wu Yi, Wang De-yu, Zhao Xiang-geng   

  1. Haikou People's Hospital Affiliated to Central South University,Haikou 570208
  • Received:2019-07-01 Online:2019-08-20 Published:2019-08-28

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摘要： 目的 评估钝性创伤患者的初始下腔静脉直径与大量输血要求之间的关系。方法 回顾性分析2014年1月1日~2017年1月1日因钝性创伤（伤害严重度评分[ISS]≥16）住院的所有患者。进行单变量和多变量分析以确定大量输血的独立预测因子（定义为在入院24 h内红细胞浓缩输血≥10单位）。计算受试者工作曲线和曲线下面积（AUC）。结果 222例患者被纳入本研究。大量输血组有50例患者,非大量输血组有172例患者,大量输血发生率为22.5％。多元回归分析结果显示,下腔静脉直径[比值比（OR）=0.88; 95％置信区间（CI）,0.80~0.96; P<0.01],纤维蛋白降解产物（FDP; OR=1.01; 95％CI：1.00~1.01; P<0.01）和纤维蛋白原水平（OR=0.99; 95％CI：0.98~1.00; P<0.01）是大量输血的强预测因子。下腔静脉直径显示中等精度（AUC：0.74;截点值：13 mm;敏感性:67%;特异性:73%）。FDP值为80.5 μg/ml,纤维蛋白原浓度为165 mg/dL,下腔静脉直径大于13 mm的组合截点值可确定不必要的大量输血的准确度为100%。结论 初始下腔静脉直径是钝性创伤患者大量输血的预测指标。

关键词: 下腔静脉直径, 大量输血, 创伤, 全身CT

Abstract: Objective To assess the relationship between the initial inferior vena cava diameter and massive transfusion requirements in patients with blunt trauma. Methods We retrospectively analyzed all patients hospitalized for blunt trauma (ISS severity≥16) from 2014 to 2017. Univariate and multivariate analyses were performed to determine independent predictors of massive transfusions (defined as ≥10 units of red cell concentrate transfusions within 24 h of admission). The subject's working curve and area under the curve (AUC) were calculated. Results Two hundred and twenty-two patients were collected, including 50 patients in the massive transfusion group and 172 patients in the non-bulk transfusion group. The incidence of massive transfusion was 22.5%. Multiple regression analysis, diameter of the inferior vena cava [odds ratio (OR): 0.88; 95% confidence interval (CI), 0.80-0.96; P<0.01], fibrin degradation product (FDP; OR: 1.01; 95% CI: 1.00 -1.01;P<0.01) and fibrinogen levels (OR: 0.99; 95% CI: 0.98-1.00; P<0.01) are strong predictors of massive transfusions. Inferior vena cava diameter showed moderate accuracy (AUC: 0.74; cut-off value: 13 mm; sensitivity: 67%; specificity: 73%). The FDP value of 80.5 μg/ml, the fibrinogen concentration of 165 mg/dL, and the combined cut-off point of the inferior vena cava diameter greater than 13 mm can determine the accuracy of unnecessary large blood transfusions to be 100%. Conclusion The initial inferior vena cava diameter is a predictor of massive blood transfusion in patients with blunt trauma.

Key words: Inferior vena cava diameter, Massive transfusion, Trauma Pan, CT scan

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