Shoemaker William C, Wo Charles C J, Lu Kevin, Chien Li-Chien, Bayard David S, Belzberg Howard, Demetriades Demetrios, Jelliffe Roger W
Laboratory of Applied Pharmcokinetics, Department of Surgery, LAC+USC Medical Center, Keck School of Medicine, University of Southern California, 1200 N. State Street, Los Angeles, CA 90033, USA.
J Trauma. 2006 Jan;60(1):82-90. doi: 10.1097/01.ta.0000203109.71608.64.
The aims are to apply a mathematical search and display model based on noninvasive hemodynamic monitoring, to predict outcome early in a consecutively monitored series of 661 severely injured patients.
A prospective observational study by a previously designed protocol in a Level I trauma service in a university-run inner city public hospital was conducted. The survival probabilities were calculated at the initial resuscitation on admission and at subsequent intervals during their hospitalization beginning shortly after admission to the emergency department. Cardiac function was evaluated by cardiac output (CI), heart rate (HR), and mean arterial blood pressure (MAP), pulmonary function by pulse oximetry (SapO2), and tissue perfusion function by transcutaneous oxygen indexed to FiO2, (PtcO2/FiO2), and carbon dioxide (PtcCO2) tension.
The survival probability (SP) averaged 89 +/- 0.4% for survivors and 75.7 +/- 1.6% (p < 0.001) for nonsurvivors in the first 24-hour period of resuscitation. The CI, MAP, SapO2, PtcO2, and PtcO2/FiO2 were significantly higher in survivors than in nonsurvivors in initial resuscitation, whereas HR and PtcCO2 were higher in nonsurvivors.
During the initial resuscitation period, misclassifications were 102 of 661 or 15%. The SP provided early objective criteria to evaluate hospital outcome and to track changes throughout the hospital course based on a large database of patients with similar clinical-hemodynamic states.
目的是应用基于无创血流动力学监测的数学搜索与显示模型，对连续监测的661例重伤患者的早期预后进行预测。
在一所大学附属市中心公立医院的一级创伤中心，按照先前设计的方案进行了一项前瞻性观察研究。在入院初始复苏时以及入院至急诊科后不久开始的住院期间的后续时间点计算生存概率。通过心输出量（CI）、心率（HR）和平均动脉压（MAP）评估心功能，通过脉搏血氧饱和度（SapO2）评估肺功能，通过经皮氧分压与吸入氧分数的比值（PtcO2/FiO2）和二氧化碳（PtcCO2）分压评估组织灌注功能。
在复苏的前24小时内，幸存者的生存概率（SP）平均为89±0.4%，非幸存者为75.7±1.6%（p<0.001）。初始复苏时，幸存者的CI、MAP、SapO2、PtcO2和PtcO2/FiO2显著高于非幸存者，而非幸存者的HR和PtcCO2更高。
在初始复苏期间，661例中有102例（15%）分类错误。基于大量具有相似临床血流动力学状态的患者数据库，SP提供了早期客观标准来评估医院预后并跟踪整个住院过程中的变化。
