Ley Eric J, Salim Ali, Kohanzadeh Som, Mirocha James, Margulies Daniel R
Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
J Trauma. 2009 Nov;67(5):1051-4. doi: 10.1097/TA.0b013e3181bba222.
The inability to mount tachycardia (T) after trauma-related hypotension is labeled relative bradycardia (RB). The objective of this study was to examine RB incidence and prognosis in a large cohort of patients.
The Los Angeles County Trauma System database, consisting of five Level I and eight Level II trauma centers, was queried for all adult (>14 years) hypotensive (systolic blood pressure [SBP] <or=90) trauma patients admitted between 1998 and 2005. RB was defined as SBP <or=90 with heart rate (HR) <or=90, and T was defined as SBP <or=90 with HR >90. Demographics, injury severity, mechanism, and outcomes were compared between the RB and T groups. Multivariate logistic regression was used to determine significant risk factors for mortality.
Of 130,906 adult trauma patients, 7,123 (5.4%) were hypotensive. After excluding patients dead on arrival and those with missing data, 3,727 patients were identified. RB was observed in 1,630 (44%) of patients, whereas T was observed in 2,097 patients (56%). RB patients were older (39.8 +/- 18.6 years vs. 35.3 +/- 17.0 years, p < 0.0001), less severely injured (injury severity score 18.0 +/- 14.2 vs. 20.5 +/- 15.3, p < 0.0001), more hypotensive (SBP 64.7 +/- 31.6 vs. 76.2 +/- 15.1, p < 0.0001), and had less abdominal trauma (abdomen abbreviated injury score 2.9 +/- 1.2 vs. 3.2 +/- 1.1, p < 0.0001) than their tachycardic counterparts. In addition, the mortality was significantly higher in the RB group compared with the T group (30.1% vs. 22.6%, p < 0.0001). Overall, RB had a higher mortality among all subgroups except older patients (age >or=55; 27.7% vs. 35.2%, p = 0.045) and patients with a higher Glasgow coma scale score (>or=12; 5.3% vs. 11.2%, p < 0.0001). Logistic regression identified RB as an independent risk factor for mortality (odds ratio, 1.60; 95% confidence interval, 1.33-1.94; p < 0.0001). When RB was further divided into two groups, observed mortality for HR <60 and HR 60 to 90 was 62.4% and 9.7%, respectively.
RB was common in hypotensive adult trauma patients; overall, it was associated with increased mortality. Patients older than 55 years and with a higher Glasgow coma scale score demonstrated decreased mortality with RB. When RB was further divided, a HR between 60 and 90 demonstrated a significant lower mortality compared with a HR <60 and to T.
创伤相关低血压后无法出现心动过速（T）被称为相对心动过缓（RB）。本研究的目的是在一大群患者中检查RB的发生率和预后。
查询洛杉矶县创伤系统数据库，该数据库由5个一级和8个二级创伤中心组成，以获取1998年至2005年间收治的所有成年（>14岁）低血压（收缩压[SBP]≤90）创伤患者。RB定义为SBP≤90且心率（HR）≤90，T定义为SBP≤90且HR>90。比较RB组和T组之间的人口统计学、损伤严重程度、机制和结局。采用多因素逻辑回归确定死亡的显著危险因素。
在130906例成年创伤患者中，7123例（5.4%）为低血压患者。排除入院时死亡和数据缺失的患者后，共识别出3727例患者。1630例（44%）患者出现RB，而2097例患者（56%）出现T。RB患者年龄更大（39.8±18.6岁对35.3±17.0岁，p<0.0001），损伤程度较轻（损伤严重程度评分18.0±14.2对20.5±15.3，p<0.0001），低血压程度更高（SBP 64.7±31.6对76.2±15.1，p<0.0001），腹部创伤比心动过速的患者少（腹部简明损伤评分2.9±1.2对3.2±1.1，p<0.0001）。此外，RB组的死亡率显著高于T组（30.1%对22.6%，p<0.0001）。总体而言，除老年患者（年龄≥55岁；27.7%对35.2%，p=0.045）和格拉斯哥昏迷量表评分较高（≥12分；5.3%对11.2%，p<0.0001）的患者外，RB在所有亚组中的死亡率均较高。逻辑回归确定RB是死亡的独立危险因素（比值比，1.60；95%置信区间，1.33 - 1.94；p<0.0001）。当RB进一步分为两组时，HR<60和HR 60至90的观察死亡率分别为62.4%和9.7%。
RB在成年低血压创伤患者中很常见；总体而言，它与死亡率增加有关。年龄大于55岁且格拉斯哥昏迷量表评分较高的患者RB死亡率降低。当RB进一步细分时，HR在60至90之间的患者死亡率显著低于HR<60的患者和T组患者。
