德国创伤注册中心数据显示，院前液体复苏对失血性休克多发伤患者的影响
Influence of prehospital fluid resuscitation on patients with multiple injuries in hemorrhagic shock in patients from the DGU trauma registry.
作者信息
Huβmann Björn, Lefering Rolf, Taeger Georg, Waydhas Christian, Ruchholtz Steffen
机构信息
Department of Trauma Surgery, University Hospital Essen, Germany.
出版信息
J Emerg Trauma Shock. 2011 Oct;4(4):465-71. doi: 10.4103/0974-2700.86630.
BACKGROUND
Severe bleeding as a result of trauma frequently leads to poor outcome by means of direct or delayed mechanisms. Prehospital fluid therapy is still regarded as the main option of primary treatment in many rescue situations. Our study aimed to assess the influence of prehospital fluid replacement on the posttraumatic course of severely injured patients in a retrospective analysis of matched pairs.
MATERIALS AND METHODS
We reviewed data from 35,664 patients recorded in the Trauma Registry of the German Society for Trauma Surgery (DGU). The following patients were selected: patients having an Injury Severity Score >16 points, who were ≥16 years of age, with trauma, excluding those with craniocerebral injuries, who were admitted directly to the participating hospitals from the accident site. All patients had recorded values for replaced volume and blood pressure, hemoglobin concentration, and units of packed red blood cells given. The patients were matched based on similar blood pressure characteristics, age groups, and type of accident to create pairs. Pairs were subdivided into two groups based on the volumes infused prior to hospitalization: group 1: 0-1500 (low), group 2: ≥2000 mL (high) volume.
RESULTS
We identified 1351 pairs consistent with the inclusion criteria. Patients in group 2 received significantly more packed red blood cells (group 1: 6.9 units, group 2: 9.2 units; P=0.001), they had a significantly reduced capacity of blood coagulation (prothrombin ratio: group 1: 72%, group 2: 61.4%; P≤0.001), and a lower hemoglobin value on arrival at hospital (group 1: 10.6 mg/dL, group 2: 9.1 mg/dL; P≤0.001). The number of ICU-free days concerning the first 30 days after trauma was significantly higher in group 1 (group 1: 11.5 d, group 2: 10.1 d; P≤0.001). By comparison, the rate of sepsis was significantly lower in the first group (group 1: 13.8%, group 2: 18.6%; P=0.002); the same applies to organ failure (group 1: 36.0%, group 2: 39.2%; P≤0.001).
CONCLUSION
The high amounts of intravenous fluid replacement was related to early traumatic coagulopathy, organ failure, and sepsis rate.
背景
创伤导致的严重出血常通过直接或延迟机制导致不良后果。在许多救援情况下，院前液体治疗仍被视为主要的初始治疗选择。我们的研究旨在通过配对回顾性分析评估院前液体补充对重伤患者创伤后病程的影响。
材料与方法
我们回顾了德国创伤外科学会（DGU）创伤登记处记录的35664例患者的数据。选择以下患者：损伤严重程度评分>16分、年龄≥16岁、有创伤且排除颅脑损伤的患者，这些患者从事故现场直接被送往参与研究的医院。所有患者均记录了补液量、血压、血红蛋白浓度以及输注的红细胞单位数。根据相似的血压特征、年龄组和事故类型对患者进行配对。根据住院前输注的液体量将配对患者分为两组：第1组：0 - 1500（低），第2组：≥2000 mL（高）。
结果
我们确定了1351对符合纳入标准的患者。第2组患者输注的红细胞显著更多（第1组：6.9单位，第2组：9.2单位；P = 0.001），他们的凝血能力显著降低（凝血酶原比率：第1组：72%，第2组：61.4%；P≤0.001），入院时血红蛋白值更低（第1组：10.6 mg/dL，第2组：9.1 mg/dL；P≤0.001）。创伤后前30天无ICU天数在第1组显著更高（第1组：11.5天，第2组：10.1天；P≤0.001）。相比之下，第一组的败血症发生率显著更低（第1组：13.8%，第2组：18.6%；P = 0.002）；器官衰竭发生率也是如此（第1组：36.0%，第2组：39.2%；P≤0.001）。
结论
大量静脉补液与早期创伤性凝血病、器官衰竭和败血症发生率相关。
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