无法挽救的患者？格拉斯哥昏迷评分最低的各类创伤患者。

Patients beyond salvation? Various categories of trauma patients with a minimal Glasgow Coma Score.

机构信息

Department of Surgery, University Medical Center Groningen, University of Groningen, The Netherlands.

出版信息

Injury. 2010 Jan;41(1):52-7. doi: 10.1016/j.injury.2009.05.030.

DOI:10.1016/j.injury.2009.05.030

PMID:19570534

Abstract

INTRODUCTION

Trauma patients in an unresponsive state upon presentation to the Emergency Department have a poor prognosis. Rapid assessment of injuries combined with life-preserving therapy is required but defining the optimal strategy can be complicated when multiple organ systems are involved. This study analysed various categories of trauma patients with a Glasgow Coma Scale (GCS) of 3 on admission and evaluated the relation between injuries, clinical condition, treatment and outcome.

PATIENTS AND METHODS

A retrospective cohort-study, performed at a level 1 Trauma Center from 2002 to 2005. Trauma patients of all ages with GCS of 3 (without sedation) and Injury Severity Score (ISS) > or = 16 were included. The collected patient data comprised data on demographics, mechanism of injury, physiological condition on admission, diagnosis, ISS, treatment, admission to Intensive Care Unit, complications and outcome.

RESULTS

Ninety-seven patients were included and divided into three groups based on the pathology that caused the GCS of 3: traumatic brain injury N=48 (49%), anoxic brain injury N=27 (28%) and haemorrhagic shock N=22 (23%). The overall mortality was 81%; 91% of the haemorrhagic shock patients, 81% of the ABI patients and 77% of the TBI patients died. Eighteen patients survived of whom five patients (5%) made a good recovery. The pupillary light response and pH on admission were related to mortality. No relation with ISS, age or hypothermia was found.

DISCUSSION

Distinguishing salvageable patients from those beyond salvation remains problematic. This study illustrated the diversity of patients, their injuries and their condition upon presentation to the hospital as well as the limitations of therapy.

CONCLUSION

Trauma patients with a GCS of 3 have a poor outcome. Despite aggressive treatment only 5% of the patients made a good recovery. Pupil reactivity and the pH on admission were found to be related to mortality.

摘要

简介

创伤患者在急诊科就诊时处于无反应状态，预后较差。需要快速评估损伤并进行生命保护治疗，但当涉及多个器官系统时，定义最佳策略可能会变得复杂。本研究分析了入院时格拉斯哥昏迷量表（GCS）评分为 3 的各种创伤患者，并评估了损伤、临床状况、治疗和结局之间的关系。

患者和方法

这是一项回顾性队列研究，于 2002 年至 2005 年在一家 1 级创伤中心进行。纳入所有年龄的 GCS 评分为 3（无镇静）且损伤严重程度评分（ISS）≥16 的创伤患者。收集的患者数据包括人口统计学数据、损伤机制、入院时生理状况、诊断、ISS、治疗、入住重症监护病房、并发症和结局。

结果

共纳入 97 例患者，根据导致 GCS 评分为 3 的病理将患者分为三组：创伤性脑损伤 48 例（49%）、缺氧性脑损伤 27 例（28%）和失血性休克 22 例（23%）。总体死亡率为 81%；失血性休克患者的死亡率为 91%，缺氧性脑损伤患者的死亡率为 81%，创伤性脑损伤患者的死亡率为 77%。18 例患者存活，其中 5 例（5%）恢复良好。入院时的瞳孔光反应和 pH 值与死亡率相关。未发现与 ISS、年龄或低体温有关。