Shapiro Nathan I, Kociszewski Chris, Harrison Tim, Chang YuChiao, Wedel Suzanne K, Thomas Stephen H
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
J Emerg Med. 2003 Aug;25(2):175-9. doi: 10.1016/s0736-4679(03)00167-7.
In patients with traumatic injuries, prehospital hypotension that resolves by Emergency Department (ED) arrival is of uncertain significance. We examined the impact of prehospital hypotension (PH) in normotensive ED patients with traumatic injuries on predicting mortality and chest/abdominal operative intervention. A retrospective cohort study was conducted of consecutive patients undergoing helicopter transport to two trauma centers between 1993 and 1997. Outcomes were mortality and chest or abdominal operative intervention. Of 545 scene transports, 55 (10.1%) patients were hypotensive on ED arrival, leaving 490 normotensive ED patients. Of 490 patients, 35 (7%) had PH and 455 (93%) had no PH. Multiple logistic regression showed the PH group to have a relative risk for death of 4.4 (95% CI: 1.2-16.6, p < 0.03) and for chest or abdominal operative intervention of 2.9 (1.1-7.6, p < 0.03). In this study of normotensive trauma center patients, prehospital hypotension was associated with increased risk of mortality and significant chest or abdominal injury.
在创伤患者中，院前低血压在急诊科（ED）就诊时已缓解，其意义尚不确定。我们研究了院前低血压（PH）对创伤后血压正常的急诊科患者死亡率及胸部/腹部手术干预的预测影响。对1993年至1997年间连续通过直升机转运至两个创伤中心的患者进行了一项回顾性队列研究。结局指标为死亡率以及胸部或腹部手术干预情况。在545例现场转运患者中，55例（10.1%）在急诊科就诊时为低血压，其余490例急诊科患者血压正常。在490例患者中，35例（7%）有院前低血压，455例（93%）无院前低血压。多因素逻辑回归分析显示，院前低血压组的死亡相对风险为4.4（95%可信区间：1.2 - 16.6，p < 0.03），胸部或腹部手术干预的相对风险为2.9（1.1 - 7.6，p < 0.03）。在这项针对血压正常的创伤中心患者的研究中，院前低血压与死亡率增加以及严重胸部或腹部损伤相关。
