Ley Eric J, Singer Matthew B, Clond Morgan A, Gangi Alexandra, Mirocha Jim, Bukur Marko, Brown Carlos V, Salim Ali
Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
J Trauma. 2011 Dec;71(6):1689-93. doi: 10.1097/TA.0b013e31823cc5df.
Although avoiding hypotension is a primary focus after trauma, elevated systolic blood pressure (SBP) is frequently disregarded. The purpose of this study was to determine the association between elevated admission SBP and delayed outcomes after trauma.
The Los Angeles County Trauma System Database was queried for all patients between 2003 and 2008 with blunt injuries who survived for at least 2 days after admission. Demographics and outcomes (pneumonia and mortality) were compared at various admission SBP subgroups (≥160 mm Hg, ≥170 mm Hg, ≥180 mm Hg, ≥190 mm Hg, ≥200 mm Hg, ≥210 mm Hg, and ≥220 mm Hg). Patients with moderate-to-severe traumatic brain injury (TBI), defined as head Abbreviated Injury Score ≥3, were then identified and compared with those without using multivariable logistic regression.
Data accessed from 14,382 blunt trauma admissions identified 2,601 patients with moderate-to-severe TBI (TBI group) and 11,781 without moderate-to-severe TBI (non-TBI group) who were hospitalized ≥2 days. Overall mortality was 2.9%, 7.1% for TBI patients, and 1.9% for non-TBI patients. Overall pneumonia was 4.6%, 9.5% for TBI patients, and 3.6% for non-TBI patients. Regression modeling determined SBP ≥160 mm Hg was a significant predictor of mortality in TBI patients (adjusted odds ratio [AOR], 1.59; confidence interval [CI], 1.10-2.29; p = 0.03) and non-TBI patients (AOR, 1.47; CI, 1.14-1.90; p = 0.003). Similarly, SBP ≥160 mm Hg was a significant predictor for increased pneumonia in TBI patients (AOR, 1.79; CI, 1.30-2.46; p = 0.0004), compared with non-TBI patients (AOR, 1.28; CI, 0.97-1.69; p = 0.08).
In blunt trauma patients with or without TBI, elevated admission SBP was associated with worse delayed outcomes. Prospective research is necessary to determine whether algorithms that manage elevated blood pressure after trauma, especially after TBI, affect mortality or pneumonia.
尽管避免低血压是创伤后主要关注的问题，但收缩压（SBP）升高常常被忽视。本研究的目的是确定入院时SBP升高与创伤后延迟性结局之间的关联。
查询洛杉矶县创伤系统数据库，纳入2003年至2008年间所有钝性伤患者，这些患者入院后存活至少2天。在不同的入院SBP亚组（≥160 mmHg、≥170 mmHg、≥180 mmHg、≥190 mmHg、≥200 mmHg、≥210 mmHg和≥220 mmHg）中比较人口统计学和结局（肺炎和死亡率）。然后确定中度至重度创伤性脑损伤（TBI）患者（头部简明损伤评分≥3），并与非TBI患者进行多变量逻辑回归比较。
从14382例钝性创伤入院患者的数据中，识别出2601例中度至重度TBI患者（TBI组）和11781例无中度至重度TBI患者（非TBI组），他们住院≥2天。总体死亡率为2.9%，TBI患者为7.1%，非TBI患者为1.9%。总体肺炎发生率为4.6%，TBI患者为9.5%，非TBI患者为3.6%。回归模型确定，SBP≥160 mmHg是TBI患者（调整比值比[AOR]，1.59；置信区间[CI]，1.10 - 2.29；p = 0.03）和非TBI患者（AOR，1.47；CI，1.14 - 1.90；p = 0.003）死亡率的显著预测因素。同样，与非TBI患者（AOR，1.28；CI，0.97 - 1.69；p = 0.08）相比，SBP≥160 mmHg是TBI患者肺炎增加的显著预测因素（AOR，1.79；CI，1.30 - 2.46；p = 0.0004）。
在有或无TBI的钝性创伤患者中，入院时SBP升高与更差的延迟性结局相关。有必要进行前瞻性研究，以确定创伤后，尤其是TBI后管理血压升高的算法是否会影响死亡率或肺炎发生率。
