[严重创伤患者的诊断性失血]

[Diagnostic blood losses in severe trauma patients].

作者信息

Vinagre Gaspar R, Cornejo Bauer C, Murillo Pérez A, Molano Alvarez E, Muñoz López O, Morales Sánchez C, López López C, Cabrero Cabrero A I, Cuenca Solanas M, García Fuentes C, Chico Fernández M, Alted López E

机构信息

UCI de Trauma y Emergencias, Hospital Universitario 12 de Octubre, Madrid, España.

出版信息

Enferm Intensiva. 2010 Jul-Sep;21(3):120-5. doi: 10.1016/j.enfi.2010.04.001. Epub 2010 Jul 4.

DOI:10.1016/j.enfi.2010.04.001

PMID:20599407

Abstract

OBJECTIVE

To analyze diagnostic (blood drawings) and iatrogenic (Continuous Renal Replacement Therapy, CRRT) blood losses (BL) in severe trauma patients.

METHOD

A one-year descriptive, prospective and observational study. We included patients over 15 years of age, admitted with severe trauma and who had a score of > or =16 on the Injury Severity Index (ISS). Those patients in whom limitation of therapeutic effort had been indicated were excluded. A total of 225 patients with 1619 days of evolution were analyzed for volume of BL/day/patient, type of diagnostic test, clinical outcome and utilization of CRRT. The variables were described as mean +/- standard deviation with the Student's T test.

RESULTS

Average blood loss of patient per day was 55.5+/-32.2 cc. Statistically significant differences were found between the blood volume drawn when the first day was compared to the second day, 73.5+/-32.2 vs. 56.3+/-21.9 (p<0.001); clinical outcome (alive vs death) 54.8+/-33 vs. 60.7+/-24.9 (p<0.05); severity (ISS<31 or > or =31) 54.65+/-20 vs. 61.5+/-28.5 (p<0.001), No RRT vs RRT: 50.9+/-18.9 vs. 97.2+/-72.6 (p<0.001).

CONCLUSIONS

The greatest diagnostic BL occurs during the resuscitation phase, in the patients who die, in those with greater severity and those undergoing CRRT.

摘要

目的

分析严重创伤患者的诊断性（采血）和医源性（连续性肾脏替代治疗，CRRT）失血情况。

方法

进行为期一年的描述性、前瞻性观察研究。纳入年龄超过15岁、因严重创伤入院且损伤严重程度评分（ISS）≥16分的患者。排除那些已表明治疗力度受限的患者。共分析了225例患者，病程达1619天，分析内容包括每日/患者的失血量、诊断测试类型、临床结局及CRRT的使用情况。变量以均值±标准差描述，并采用学生t检验。

结果

患者每日平均失血量为55.5±32.2毫升。第一天与第二天采血血量存在统计学显著差异，分别为73.5±32.2与56.3±21.9（p<0.001）；临床结局（存活与死亡）分别为54.8±33与60.7±24.9（p<0.05）；严重程度（ISS<31或≥31）分别为54.65±20与61.5±28.5（p<0.001）；未进行肾脏替代治疗（RRT）与进行RRT的情况分别为50.9±18.9与97.2±72.6（p<0.001）。