重大创伤患者的院前呼气末二氧化碳浓度与预后
Prehospital end-tidal carbon dioxide concentration and outcome in major trauma.
作者信息
Deakin Charles D, Sado Daniel M, Coats Timothy J, Davies Gareth
机构信息
Helicopter Emergency Service, Royal London Hospital, Whitechapel, London, United Kingdom.
出版信息
J Trauma. 2004 Jul;57(1):65-8. doi: 10.1097/01.ta.0000103984.70306.22.
BACKGROUND
End-tidal carbon dioxide (Petco2) concentration is a marker of the pathophysiologic state because it is a reflection of cardiac output. Petco2 correlates with outcome after prehospital primary cardiac arrest, but association with outcome from prehospital trauma has not been established.
METHODS
Between 1998 and 2001, Petco2 was recorded in 191 blunt trauma patients requiring prehospital intubation. Rapid sequence intubation was performed using suxamethonium (1 mg/kg) and etomidate (0.2-0.3 mg/kg). Initial Petco2 after endotracheal intubation (t0) and Petco2 at 20 minutes after endotracheal intubation (t20) were recorded, together with survival to discharge.
RESULTS
Median Petco2 at t20 was 4.10 kPa in survivors and 3.50 kPa in nonsurvivors (95% confidence interval of difference between medians, 0.40 to 0.90 kPa; p < 0.0001). Petco2 at t20 was a better predictor of outcome than at t0.
CONCLUSION
Only 5% patients with Petco2 < 3.25 kPa survived to discharge. Petco2 at t20 is of value in predicting outcome from major trauma.
背景
呼气末二氧化碳（Petco2）浓度是病理生理状态的一个指标，因为它反映心输出量。Petco2与院外原发性心脏骤停后的预后相关，但与院外创伤预后的关联尚未确立。
方法
1998年至2001年间，对191例需要院外插管的钝性创伤患者记录了Petco2。使用琥珀酰胆碱（1mg/kg）和依托咪酯（0.2 - 0.3mg/kg）进行快速顺序插管。记录气管插管后初始Petco2（t0）和气管插管后20分钟时的Petco2（t20），以及出院生存率。
结果
幸存者t20时Petco2中位数为4.10kPa，非幸存者为3.50kPa（中位数差异的95%置信区间为0.40至0.90kPa；p < 0.0001）。t20时的Petco2比t0时更能预测预后。
结论
Petco2 < 3.25kPa的患者中只有5%存活至出院。t20时的Petco2对预测严重创伤的预后有价值。
Zotero 插件