Mizushima Yasuaki, Ueno Masato, Watanabe Hiroaki, Ishikawa Kazuo, Matsuoka Tetsuya
Osaka Prefectural Senshu Critical Care Medical Center, Osaka, Japan.
J Trauma. 2011 Oct;71(4):789-92. doi: 10.1097/TA.0b013e31822f7bbd.
Tachycardia is an important early sign of shock in trauma. Although the base deficit (BD) and lactate are indicative of hypoperfusion and known to predict mortality, some cases show a discrepancy between heart rate (HR) and BD or lactate; such cases have poor prognosis. The objective of this study was to examine whether lack of tachycardia after hypoperfusion is associated with increased mortality.
Retrospective data were collected on 1,742 adult trauma patients. Mortality was compared with different levels of BD, lactate, and HR on admission. Multivariate logistic regression was used to identify significant risk factors for mortality.
Significantly increased mortality was observed in patients with hypoperfusion (BD less than -5 mmol/L or lactate more than 5 mmol/L). Among these patients, those with a normal HR (<80 bpm) were associated with a higher mortality rate than those with tachycardia (HR, 80-100 or>100 bpm). However, systolic blood pressure (SBP) was not significantly different between the different HR groups. Logistic regression analysis revealed that discrepancy between HR and indicators of hypoperfusion (Dis BD: BD less than -5 mmol/L and HR less than 80 bpm; or Dis lac: lactate more than 5 mmol/L and HR less than 80 bpm) are independent predictors of mortality after controlling for age, SBP, Injury Severity Score, head Abbreviated Injury Scale, HR, and BD or lactate (Dis BD: odds ratio, 2.67; 95% confidence interval, 1.07-6.61; p<0.05 and Dis lac: odds ratio, 4.11; 95% confidence interval, 1.57-10.74; p<0.01, respectively).
The lack of tachycardia in the presence of hypoperfusion is associated with poor prognosis independent of injury severity, SBP, and head injury. A discrepancy between HR and indicators of hypoperfusion could be considered as a predictor of mortality in trauma patients.
心动过速是创伤性休克的重要早期体征。尽管碱缺失（BD）和乳酸水平可提示灌注不足且已知能预测死亡率，但部分病例的心率（HR）与BD或乳酸水平之间存在差异；此类病例预后较差。本研究的目的是探讨灌注不足后无心动过速是否与死亡率增加相关。
收集了1742例成年创伤患者的回顾性数据。比较入院时不同BD、乳酸水平和心率水平下的死亡率。采用多因素逻辑回归分析确定死亡率的显著危险因素。
灌注不足（BD小于-5 mmol/L或乳酸大于5 mmol/L）的患者死亡率显著增加。在这些患者中，心率正常（<80次/分钟）者的死亡率高于心动过速（心率80 - 100或>100次/分钟）者。然而，不同心率组之间的收缩压（SBP）无显著差异。逻辑回归分析显示，在控制年龄、SBP、损伤严重程度评分、头部简明损伤量表、心率以及BD或乳酸水平后，心率与灌注不足指标之间的差异（Dis BD：BD小于-5 mmol/L且心率小于80次/分钟；或Dis lac：乳酸大于5 mmol/L且心率小于80次/分钟）是死亡率的独立预测因素（Dis BD：比值比，2.67；95%置信区间，1.07 - 6.61；p<0.05；Dis lac：比值比，4.11；95%置信区间，1.57 - 10.74；p<0.01）。
灌注不足时无心动过速与预后不良相关，且与损伤严重程度、SBP和头部损伤无关。心率与灌注不足指标之间的差异可被视为创伤患者死亡率的预测指标。
