Assessment of Severity and Prognosis of Polytrauma Outcome: the Current State of the Problem (Review)
Assessment of Severity and Prognosis of Polytrauma Outcome: the Current State of the Problem (Review)
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多发伤结果的严重性和预后评估：问题的现状（综述）
DOI：
10.17691/stm2017.9.2.25
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Y. Shapkin
中科院分区：
文献类型：
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作者：
P. Seliverstov;Y. Shapkin
本文综述了评估多发伤严重程度和预测预后的现代方法。为了解决多重创伤严重程度的客观评价问题，许多研究致力于寻找其预后的独立预测因子，其中许多研究将其纳入各种量表和统计模型中，在既定的区间内对损伤的严重程度进行定量排序，并计算生存概率。人们普遍认为要考虑解剖学标准来确定损伤的严重程度，以及表征身体功能系统对损伤反应的生理参数。年龄、性别、合并症、各种临床参数、酸中毒指标、凝血功能障碍、氧化应激、炎症反应、及时诊断和治疗质量、是否需要进行各种急救被认为是致死性多发伤结局的独立危险因素。评估损伤严重程度（ISS， NISS， APS， ICISS， TMPM）和功能障碍（GCS， RTS, APACHE II, MODS II， SOFA, SAPS II, MPM II）以及各种临床和解剖联合评估系统（TRISS， ASCOT, RISC II， PTS等）的预测价值和比较有效性正在现代文献中得到积极讨论。由于多重创伤引起的各种损伤和紊乱，以及对损伤结果预测因素的研究不足，创建一个通用量表变得复杂。建议的存活率和预后因素与特定的多重创伤数据库有关，这些数据库在死亡率和医疗保健质量方面有所不同，这反映在它们的预测价值上。明确多发伤的定义，形成统一的严重程度评估体系，有利于医生规范治疗政策，客观解决重伤员医疗救助的组织和资金支持问题。
The review deals with modern methods of assessing the severity and predicting the outcome of polytrauma. To solve the problem of objective evaluation of polytrauma severity, numerous studies are devoted to the search for independent predictors of its outcome, many of which are included in various scales and statistical models to quantitatively rank the severity of injury in the established intervals and calculate the survival probability. It is generally accepted to take into account the anatomical criteria to determine the severity of damage, and physiological parameters that characterize the response of the body functional systems to the damage. Age, sex, comorbidities, various clinical parameters, indices of acidosis, coagulopathy, oxidative stress, inflammatory response, timely diagnosing and the quality of treatment, the need of rendering various types of emergency aid are considered as independent risk factors of fatal polytrauma outcome. The predictive value and comparative effectiveness used in polytrauma scales assessing the severity of injuries (ISS, NISS, APS, ICISS, TMPM) and functional disorders (GCS, RTS, APACHE II, MODS II, SOFA, SAPS II, MPM II) as well as a variety of combined clinical and anatomical evaluation systems (TRISS, ASCOT, RISC II, PTS, etc.) are being actively discussed in the modern literature. Creating a universal scale is complicated by a variety of damages and disorders caused by a polytrauma, and insufficient study of injury outcome predictors. The proposed survival rates and prognostic factors are tied to specific polytrauma databases differing in terms of mortality and quality of medical care, which is reflected in their predictive value. A clear definition of polytrauma and formation of a unified system of assessing its severity would allow physicians to standardize treatment policy, objectively solve the problems of organization and financial support of medical help to seriously injured people.