Martin Jeremiah T, Alkhoury Fuad, O'Connor Judith A, Kyriakides Tassos C, Bonadies John A
Department of Surgery, Hospital of St. Raphael, New Haven, Connecticut 06511, USA.
Am Surg. 2010 Jan;76(1):65-9.
Base deficit (BD) and lactic acid (LA) are accepted markers of hypoperfusion and predictors of outcome in the trauma patient and we aim to assess the value of these markers in the triage of the elderly with "normal" vital signs. Patients older than age 65 who presented between 1997 and 2004 but who did not have isolated head injuries were included. Three patient groups were established: normal, occult hypoperfusion (OH), and shock. Outcome measures included mortality, hospital length of stay, intensive care unit length of stay, and discharge disposition. One hundred six patients were included in the analysis and had similar Injury Severity Scores. Mean systolic blood pressure was similar in the normal and OH groups. Forty-two per cent of patients had abnormal BD or LA in the emergency room indicating OH. These patients were more likely to have a longer intensive care unit length of stay (8.6 days vs. 3 days; P = 0.01) and were also more likely to be discharged to a nursing facility (P = 0.03). The trend was toward increased mortality in the OH group. OH is a common finding in elderly trauma patients. Outcomes in these patients are different and more like those presenting in shock.
碱缺失（BD）和乳酸（LA）是公认的低灌注指标及创伤患者预后的预测指标，我们旨在评估这些指标在对生命体征“正常”的老年患者进行分诊时的价值。纳入了1997年至2004年间就诊的65岁以上且无孤立性头部损伤的患者。设立了三组患者：正常组、隐匿性低灌注（OH）组和休克组。结局指标包括死亡率、住院时间、重症监护病房住院时间和出院去向。106例患者纳入分析，其损伤严重程度评分相似。正常组和OH组的平均收缩压相似。42%的患者在急诊室时BD或LA异常，提示OH。这些患者更有可能有更长的重症监护病房住院时间（8.6天对3天；P = 0.01），也更有可能被转至护理机构（P = 0.03）。OH组有死亡率增加的趋势。OH在老年创伤患者中很常见。这些患者的预后不同，更类似于休克患者的预后。
