Fleming A, Bishop M, Shoemaker W, Appel P, Sufficool W, Kuvhenguwha A, Kennedy F, Wo C J
Department of Surgery, Charles R. Drew University of Medicine & Science, Martin Luther King Jr/Drew Medical Center, Los Angeles, CA 90059.
Arch Surg. 1992 Oct;127(10):1175-9; discussion 1179-81. doi: 10.1001/archsurg.1992.01420100033006.
We prospectively tested the effect of the early postinjury attainment of supranormal values of cardiac index (> or = 4.52 L/min per square meter), oxygen delivery (> or = 670 mL/min per square meter), and oxygen consumption (> or = 166 mL/min per square meter) on outcome in traumatized patients with an estimated blood loss of 2000 mL or more. The goals in control patients were to attain normal values for all hemodynamic measurements. During the 6-month period, 33 protocol patients and 34 control patients with similar vital signs, estimated blood losses, and severity of injuries were enrolled in the study. Eight (24%) protocol patients died, while 15 (44%) control patients died. The protocol patients had fewer mean (+/- SEM) organ failures per patient (0.76 +/- 1.21 vs 1.59 +/- 1.60), shorter stays in the intensive care unit (5 +/- 3 vs 12 +/- 12), and fewer mean days requiring ventilation (4 +/- 3 vs 11 +/- 10) than did the control patients (P < .05 for each). We conclude that attaining supranormal circulatory values improves survival and decreases morbidity in the severely traumatized patient.
我们前瞻性地测试了创伤后早期达到心脏指数超正常水平（≥4.52升/分钟每平方米）、氧输送超正常水平（≥670毫升/分钟每平方米）和氧消耗超正常水平（≥166毫升/分钟每平方米）对估计失血量2000毫升或更多的创伤患者预后的影响。对照患者的目标是所有血流动力学测量值达到正常水平。在6个月期间，33例遵循方案的患者和34例具有相似生命体征、估计失血量和损伤严重程度的对照患者被纳入研究。8例（24%）遵循方案的患者死亡，而15例（44%）对照患者死亡。与对照患者相比，遵循方案的患者平均（±标准误）每位患者的器官衰竭更少（0.76±1.21对1.59±1.60），在重症监护病房的停留时间更短（5±3对12±12），需要机械通气的平均天数更少（4±3对11±10）（每项P<0.05）。我们得出结论，达到超正常循环值可提高严重创伤患者的生存率并降低发病率。
