Ley Eric J, Clond Morgan A, Srour Marissa K, Barnajian Moshe, Mirocha James, Margulies Dan R, Salim Ali
Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
J Trauma. 2011 Feb;70(2):398-400. doi: 10.1097/TA.0b013e318208f99b.
Recent evidence suggests a survival advantage in trauma patients who receive controlled or hypotensive resuscitation volumes. This study examines the threshold crystalloid volume that is an independent risk factor for mortality after trauma.
This study analyzed prospectively collected data from a Level I Trauma Center between January 2000 and December 2008. Demographics and outcomes were compared in elderly (≥70 years) and nonelderly (<70 years) trauma patients who received crystalloid fluid in the emergency department (ED) to determine a threshold volume that was an independent predictor for mortality.
A total of 3,137 patients who received crystalloid resuscitation in the ED were compared. Overall mortality was 5.2%. Mortality among the elderly population was 17.3% (41 deaths), whereas mortality in the nonelderly population was 4% (116 deaths). After multivariate logistic regression analysis, fluid volumes of 1.5 L or more were significantly associated with mortality in both elderly (odds ratio [OR]: 2.89, confidence interval [CI] [1.13-7.41], p=0.027) and nonelderly patients (OR: 2.09, CI [1.31-3.33], p=0.002). Fluid volumes up to 1 L were not associated with significantly increased mortality. At 3 L, mortality was especially pronounced in the elderly (OR: 8.61, CI [1.55-47.75] p=0.014), when compared with the nonelderly (OR=2.69, CI [1.53-4.73], p=0.0006).
ED volume replacement of 1.5 L or more was an independent risk factor for mortality. High-volume resuscitations were associated with high-mortality particularly in the elderly trauma patient. Our finding supports the notion that excessive fluid resuscitation should be avoided in the ED and when required, operative intervention or intensive care admission should be considered.
近期证据表明，接受控制性或低血压复苏量的创伤患者具有生存优势。本研究旨在探讨晶体液量阈值，其是创伤后死亡的独立危险因素。
本研究分析了2000年1月至2008年12月期间一级创伤中心前瞻性收集的数据。比较了在急诊科（ED）接受晶体液治疗的老年（≥70岁）和非老年（<70岁）创伤患者的人口统计学和结局，以确定作为死亡独立预测因素的阈值量。
共比较了3137例在ED接受晶体复苏的患者。总体死亡率为5.2%。老年人群死亡率为17.3%（41例死亡），而非老年人群死亡率为4%（116例死亡）。多因素逻辑回归分析后，1.5L或更多的液体量与老年患者（比值比[OR]：2.89，置信区间[CI][1.13 - 7.41]，p = 0.027）和非老年患者（OR：2.09，CI[1.31 - 3.33]，p = 0.002）的死亡率均显著相关。1L及以下的液体量与死亡率显著增加无关。在3L时，与非老年患者（OR = 2.69，CI[1.53 - 4.73]，p = 0.0006）相比，老年患者的死亡率尤其显著（OR：8.61，CI[1.55 - 47.75]，p = 0.014）。
ED补液量1.5L或更多是死亡的独立危险因素。大量复苏与高死亡率相关，尤其是在老年创伤患者中。我们的发现支持在ED应避免过度液体复苏这一观点，并且在需要时，应考虑手术干预或重症监护入院。
