To Investigate The Evaluation Value Of APACHEⅡ Score And Oxygen Metabolism Indexes On The Condition Evaluation And 28-Day Prognosis Of Adult Patients With Severe Multiple Trauma

Objective:To investigate the evaluation value of APACHE II score and oxygen metabolism indexes[central vein-arterial carbon dioxide partial pressure difference/arterial-venous oxygen delivery difference ratio（Pcv-aCO₂/Da-vO₂）、central vein-arterial carbon dioxide partial pressure difference（Pcv-aCO₂）、central venous oxygen saturation（ScvO₂）、Lactate（Lac）、Lactic acid clearance at 6 hours（T6h Lac）、Change rate of central vein-arterial carbon dioxide partial pressure difference/arterial-venous oxygen delivery difference ratio at 6 hours（T6h Pcv-aCO₂/Da-vO₂）]on the condition evaluation and 28-day prognosis of adult patients with severe multiple trauma.Methods:This study was a retrospective clinical study.A total of 201patients with severe multiple trauma who visited the Five Hospitals of Zunyi Medical University[The Fifth Affiliated hospital of Zunyi Medical University（Zhuhai）]and Dongguan Donghua Hospital（Donghua Hospital affiliated to Sun Yat-sen University）from January 2020 to December 2021 were counted.A total of 113 patients were included in the study group.The end point was 28days after admission.Prognosis at day 28 was divided into survival group（n=72）and death group（n=41）.The diagnosis and treatment of the enrolled patients were in accordance with the relevant guidelines for the diagnosis and treatment of patients with severe multiple trauma.Relevant basic clinical data[gender,age,hospitalization cost,length of ICU stay,length of stay,APACHE II score)were collected after enrollment.And blood gas analysis indexes（Lac、ScvO₂、Pcv-aCO₂、Pcv-aCO₂/Da-vO₂ ratio）obtained on First time on admission Day（T0）,day 3（T3）,Day 5（T5）,Day 7（T7）、Blood gas analysis at 6 hours after T0（T6h）.The 6-hour lactic acid clearance rate（T6h Lac）,and Change rate of central vein-arterial carbon dioxide partial pressure difference/arterial-venous oxygen delivery difference ratio at 6 hours（T6h Pcv-aCO₂/Da-vO₂）were calculated].All the experimental data and adult patients with severe multiple trauma condition and prognosis for correlation analysis,draw the receiver-operating characteristic curve（ROC curve）,comparing the indicators for adult patients with severe multiple trauma condition and prognosis assessment value,further by the use of joint experiment data is analyzed to compare the value of the diagnosis of experimental outcomes and the superiority of efficiency.Results:1.The mean hospital stay of patients in the death group was 3 days,and the sample data of T3,T5 and T7 blood gas indexes（Lac、ScvO₂、Pcv-aCO₂、Pcv-aCO₂/Da-vO₂）were largely missing for comparative analysis,so they were abandoned.2.The length of hospital stay,length of ICU stay and Pcv-aCO₂/Da-vO₂ratio were significantly negatively correlated（r<0,P<0.05）,and Lac clearance rate and Pcv-aCO₂/Da-vO₂ change rate were significantly positively correlated（r>0,P<0.05）.There were no significant differences in length of hospital stay,length of ICU stay,APACHE II score,T0 Lac,T0 ScvO₂,T0 Pcv-aCO₂（P>0.05）.3.The higher the ratio of Lac,Pcv-aCO₂,Pcv-aCO₂/Da-vO₂ ratio,the more severe the disease of adult patients with severe multiple trauma.The lower the Lac clearance rate and Pcv-aCO₂/Da-vO₂ change rate,the more severe the disease of adult patients with severe multiple trauma.4.APACHE II score,Pcv-aCO₂,and Pcv-aCO₂/Da-vO₂ ratio in death group were higher than those in survival group（P<0.05）;Lac,6-hour Lac clearance rate and change rate of Pcv-aCO₂/Da-vO₂ in survival group were higher than those in death group（P<0.05）,ScvO₂ showed no significant difference between groups（P>0.05）.5.Pcv-aCO₂,Pcv-aCO₂/Da-vO₂ ratio and Pcv-aCO₂/Da-vO₂ change rates were independent risk factors for poor prognosis in adult patients with severe multiple trauma（P<0.05）;APACHE II score,Lac,Lac clearance rate and death were independently correlated（P>0.05）.6.ROC curve and corresponding area display:Change rate of Pcv-aCO₂/Da-vO₂ within 6 hours（0.895）>6-hour Lac clearance rate（0.828）>Pcv-aCO₂/Da-vO₂（0.787）>APACHE II score（0.758）>Lac（0.649）>Pcv-aCO₂（0.634）.ScvO₂is not efficient.7.The ranking of diagnostic efficacy of single index is as follows:Pcv-aCO₂/Da-vO₂ change rate（0.708）>Lac clearance rate（0.648）>Pcv-aCO₂/Da-vO₂（0.572）>APACHE II score（0.565）>Lac（0.387）.8.The optimal diagnostic performance index of parallel test was APACHE II score and Pcv-aCO₂/Da-vO₂ change rate combined test（Diagnostic index:0.645）.9.The best diagnostic performance index of series test was:combined test of Pcv-aCO₂/Da-vO₂ ratio and change rate of Pcv-aCO₂/Da-vO₂（Diagnostic index:0.749）.Conclusions:1.Lac,Pcv-aCO₂,Pcv-aCO₂/Da-vO₂ ratio,Lac clearance rate and Pcv-aCO₂/Da-vO₂ change rate can be used as good indicators to evaluate the severity of adult patients with severe multiple trauma.2.Single index diagnostic efficiency of this test:Pcv-aCO₂/Da-vO₂ rate of change was better than APACHE II score,and the prognostic value of Pcv-aCO₂/Da-vO₂ score was the best for adult patients with severe multiple injuries,with a diagnostic index of 0.708.3.In the multi-index combined test of this experiment:Pcv-aCO₂/Da-vO₂ratio and Pcv-aCO₂/Da-vO₂ rate of change in series test（diagnostic index:0.749）the prognostic value of adult patients with severe multiple trauma was better than the parallel test of APACHE II score and Pcv-aCO₂/Da-vO₂ rate of change（diagnostic index:0.645）.