Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
J Surg Res. 2010 Sep;163(1):142-5. doi: 10.1016/j.jss.2010.04.046. Epub 2010 May 20.
Increasing data indicate treatment with beta blockers might improve survival after traumatic brain injury (TBI); the optimal heart rate (HR) range for these patients is unknown. To guide treatment, admission HR in moderate to severe TBI patients was analyzed to determine if a specific range is associated with decreased mortality.
The Los Angeles County Trauma System Database, consisting of five Level I and 8 Level II trauma centers, was queried for all injured patients admitted between 1998 and 2005 (n = 147,788). Isolated moderate to severe TBI patients (head abbreviated injury score > or = 3) were then identified. Demographics and outcomes were compared at various admission HR subgroups (<50, 50-59, 60-69, 70-79, 80-89, 90-99, 100-109, > or =110). Logistic regression was then performed to determine predictors of mortality.
After exclusions, a total of 11,977 isolated moderate to severe isolated TBI patients were analyzed, overall mortality was 11.5% with a trend toward lowest mortality at HR 80 to 89 (7.3%). Each HR subgroup had a significantly increased unadjusted odds ratio for mortality compared with HR 80 to 89, except HR 90 to 99 (OR 1.2, CI 1.0-1.5) and HR 100 to 109 (OR 1.2, CI 1.0-1.5). In multivariable logistic regression analysis, HR <50, 50-59, 60-69, and > or =110 were independent predictors for increased mortality compared with HR 80-89.
After isolated moderate to severe TBI, HR <50, 50-59, 60-69, and > or =110 were independent predictors of increased mortality. HR outside the range 70-109 could serve as a marker for aggressive resuscitation. As mortality increased significantly with HR: <50 (AOR 4.70), 50-59 (AOR 2.21), and 60-69 (AOR 1.63), our findings recommend avoiding HR < 70 in patients with moderate to severe TBI.
越来越多的数据表明，β受体阻滞剂治疗可能会改善创伤性脑损伤（TBI）患者的生存率；但这些患者的最佳心率（HR）范围尚不清楚。为了指导治疗，分析了中度至重度 TBI 患者入院时的 HR，以确定特定范围是否与死亡率降低有关。
使用由五个一级和 8 个二级创伤中心组成的洛杉矶县创伤系统数据库，对 1998 年至 2005 年间入院的所有受伤患者（n = 147788）进行了查询。然后确定孤立性中度至重度 TBI 患者（头部简略损伤评分≥3）。在不同的入院 HR 亚组（<50、50-59、60-69、70-79、80-89、90-99、100-109、≥110）比较了人口统计学和结局。然后进行 logistic 回归分析，以确定死亡率的预测因素。
排除后，共分析了 11977 例孤立性中度至重度孤立性 TBI 患者，总体死亡率为 11.5%，HR 为 80-89 时死亡率最低（7.3%）。与 HR 80-89 相比，每个 HR 亚组的未调整死亡率比值比均显著增加，除 HR 90-99（OR 1.2，CI 1.0-1.5）和 HR 100-109（OR 1.2，CI 1.0-1.5）外。在多变量 logistic 回归分析中，HR<50、50-59、60-69 和≥110 与 HR 80-89 相比，是死亡率增加的独立预测因素。
在孤立性中度至重度 TBI 后，HR<50、50-59、60-69 和≥110 是死亡率增加的独立预测因素。HR 在 70-109 范围之外可能是积极复苏的标志。由于死亡率随着 HR 的增加而显著增加：<50（AOR 4.70）、50-59（AOR 2.21）和 60-69（AOR 1.63），我们的研究结果建议避免中度至重度 TBI 患者的 HR<70。
