摘要： 目的 探讨急诊医生主导的床旁超声创伤重点超声评估法（FAST）联合血清C反应蛋白（CRP）、降钙素原（PCT）及白细胞介素-6 （IL-6）检测对急性胸腹创伤患者结局的预测价值。方法 选取2019年2月至2022年2月我院急诊科收治的96例急性胸腹创伤患者作为研究对象，根据患者临床结局（治疗48 h后生存状态）分为死亡组（n=14）和生存组（n=82）。比较2组一般临床指标（性别、年龄、体质量、创伤类型、吸烟史、饮酒史及既往胸腹部手术史）、CRAMS评分、下腔静脉-塌陷指数（IVC-CI）及入院即刻（0 h），24、48 h时血清CRP、PCT、IL-6水平；将2组有统计学差异（P < 0.05）指标进行logistic回归分析急性胸腹创伤患者结局的影响因素。绘制IVC-CI及入院48 h血清CRP、PCT、IL-6单独及联合检测的受试者操作特征（ROC）曲线，评估IVC-CI、血清CRP、PCT、IL-6水平及联合检测对临床结局的预测价值。结果 死亡组入院0 h、24 h及48 h血清CRP、PCT、IL-6水平，CRAMS评分，IVC-CI均高于生存组（均P < 0.001）。死亡组患者血清CRP、PCT、IL-6水平从入院0 h至48 h时逐渐增高，各时间点比较差异有统计学意义（均P < 0.05）；生存组患者血清CRP、PCT、IL-6水平从入院0 h至24 h升至最高，入院48 h时下降，各时间点比较差异均有统计学意义（均P < 0.05）。logistic回归分析结果显示CRAMS评分、IVC-CI及血清CRP、PCT、IL-6水平是影响急性胸腹创伤患者结局的危险因素（均P < 0.05）。IVC-CI联合血清CRP、PCT、IL-6检测的AUC值大于各单独指标（均P < 0.05），且采用IVC-CI联合血清CRP、PCT、IL-6检测预测急性胸腹创伤患者临床结局具有临床净获益。结论 IVC-CI及血清CRP、PCT、IL-6水平与急性胸腹创伤患者临床结局相关；急诊医生主导的床旁超声FAST联合入院48 h血清CRP、PCT、IL-6检测可以预测急性胸腹部创伤患者的临床结局，且预测效能较好。

床旁超声FAST联合血清CRP、PCT、IL-6检测对急性胸腹创伤患者结局的预测价值

罗耀兵¹, 叶丰宁², 肖龙敏³, 刘勇¹

1. 恩施土家族苗族自治州民族医院急诊科, 湖北 恩施 445000;
2. 恩施土家族苗族自治州民族医院超声影像科, 湖北 恩施 445000;
3. 恩施土家族苗族自治州民族医院胸外科, 湖北 恩施 445000

收稿日期:2023-02-28出版日期:2024-02-28发布日期:2024-01-12
通讯作者:刘勇E-mail:26008511@qq.com
作者简介:罗耀兵(1981-),男,副主任医师,硕士.
基金资助:湖北省卫生健康委员会科研项目（WJ2019F151）


关键词: 急性胸腹创伤, 创伤重点超声评估法, 下腔静脉-塌陷指数, C反应蛋白, 降钙素原, 白细胞介素-6
Abstract: Objective To investigate the value of emergency physician-led focused assessment with sonography for trauma (FAST) combined with serum C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6) testing in predicting the clinical outcome of patients with acute chest and abdominal trauma. Methods Ninety-six patients with acute thoracoabdominal trauma, who had been admitted to the Department of Emergency in our hospital from February 2019 to February 2022, were selected for this study. The patients were grouped according to their clinical outcomes, with the individuals who died after 48 h of treatment classified to the death group (n=14) and all the others to the survival group (n=82). The general clinical indicators (sex, age, body mass, trauma type, smoking history, alcohol consumption history, and previous chest and abdominal surgery history), CRAMS scores, inferior vena cava-collapse index (IVC-CI), and serum CRP, PCT, and IL-6 levels at 0, 24, and 48 h after admission were compared between the two groups. Logistic regression analysis was used to identify the factors that influence the outcomes of patients with acute thoracoabdominal trauma based on statistically significant differences (P < 0.05) between the two groups. Receiver operating characteristic (ROC) curves of the IVC-CI combined with serum CRP, PCT, and IL-6 detection were plotted to evaluate the value in predicting clinical outcomes. Results The serum CRP, PCT, and IL-6 levels, CRAMS score, and IVC-CI in the death group were higher than those in the survival group at 0, 24, and 48 h after admission (all P < 0.001). The serum CRP, PCT, and IL-6 levels in patients in the death group gradually increased from 0, 24, and 48 h after admission, and the differences between each time point were statistically significant (all P < 0.05). In the patients in the survival group, these serum protein levels increased from 0 to 24 h after admission and peaked at 48 h, and the differences between each time point were statistically significant (all P < 0.05). The logistic regression analysis showed that the CRAMS score, IVC-CI, and serum CRP, PCT, and IL-6 levels were risk factors affecting the outcome of patients with acute chest and abdominal trauma (all P < 0.05). The area under the ROC curve for the IVC-CI combined with serum CRP, PCT, and IL-6 detection was greater than that for each individual assessment type alone (all P < 0.05), and the use of the IVC-CI combined with serum CRP, PCT, and IL-6 detection to predict the clinical outcome of patients with acute chest and abdominal trauma had net clinical benefit. Conclusion The IVC-CI and serum CRP, PCT, and IL-6 levels were associated with the clinical outcomes of patients with acute thoracoabdominal trauma. Therefore, emergency physician-led bedside ultrasound FAST combined with 48 h serum CRP, PCT, and IL-6 testing has good value for predicting the clinical outcomes of patients with acute chest and abdominal trauma.
Key words: acute thoracoabdominal trauma, focused assessment with sonography for trauma, inferior vena cava-collapse index, C-reactive protein, procalcitonin, interleukin-6
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