基础缺陷作为创伤后生存的标志物：在不断变化的患者人群和复苏模式中具有一致性。
Base deficit as a marker of survival after traumatic injury: consistent across changing patient populations and resuscitation paradigms.
机构信息
Department of Surgery, Emory University School Medicine, Grady Memorial Hospital, Atlanta, Georgia 30303, USA.
出版信息
J Trauma Acute Care Surg. 2012 Apr;72(4):844-51. doi: 10.1097/TA.0b013e31824ef9d2.
BACKGROUND
Damage control resuscitation (DCR) has improved outcomes in severely injured patients. In civilian centers, massive transfusion protocols (MTPs) represent the most formal application of DCR principles, ensuring early, accurate delivery of high fixed ratios of blood components. Recent data suggest that DCR may also help address early trauma-induced coagulopathy. Finally, base deficit (BD) is a long-recognized and simple early prognostic marker of survival after injury.
METHODS
Outcomes of patients with admission BD data resuscitated during the DCR era (2007-2010) were compared with previously published data (1995-2003) of patients cared for before the DCR era (pre-DCR). Patients were considered to have no hypoperfusion (BD, >-6), mild (BD, -6 to -14.9), moderate (BD, -15 to -23.9), or severe hypoperfusion (BD, <-24).
RESULTS
Of 6,767 patients, 4,561 were treated in the pre-DCR era and 2,206 in the DCR era. Of the latter, 218 (9.8%) represented activations of the MTP. DCR patients tended to be slightly older, more likely victims of penetrating trauma, and slightly more severely injured as measured by trauma scores and BD. Despite these differences, overall survival was unchanged in the two eras (86.4% vs. 85.7%, p = 0.67), and survival curves stratified by mechanism of injury were nearly identical. Patients with severe BD who were resuscitated using the MTP, however, experienced a substantial increase in survival compared with pre-DCR counterparts.
CONCLUSION
Despite limited adoption of formal DCR, overall survival after injury, stratified by BD, is identical in the modern era. Patients with severely deranged physiology, however, experience better outcomes. BD remains a consistent predictor of mortality after traumatic injury. Predicted survival depends more on the energy level of the injury (stab wound vs. nonstab wound) than the mechanism of injury (blunt vs. penetrating).
背景
损伤控制性复苏（DCR）已改善严重创伤患者的预后。在民用中心，大量输血方案（MTP）代表了 DCR 原则的最正式应用，确保早期、准确地提供高固定比例的血液成分。最近的数据表明，DCR 也可能有助于解决早期创伤诱导的凝血障碍。最后，碱缺失（BD）是一种长期公认的、简单的创伤后生存预后标志物。
方法
比较了在 DCR 时代（2007-2010 年）接受 BD 数据复苏的患者的结局与之前发表的 DCR 时代之前（1995-2003 年）接受治疗的患者的数据（前 DCR）。患者被认为没有低灌注（BD，>-6）、轻度低灌注（BD，-6 至-14.9）、中度低灌注（BD，-15 至-23.9）或严重低灌注（BD，<-24）。
结果
在 6767 例患者中，4561 例在前 DCR 时代治疗，2206 例在后 DCR 时代治疗。后者中有 218 例（9.8%）为 MTP 的激活。DCR 患者的年龄略大，更可能是穿透性创伤的受害者，创伤评分和 BD 显示受伤程度略重。尽管存在这些差异，但两个时代的总体生存率无变化（86.4% vs. 85.7%，p=0.67），且按损伤机制分层的生存率曲线几乎相同。然而，使用 MTP 复苏的严重 BD 患者的生存率与前 DCR 患者相比显著提高。
结论
尽管 DCR 的应用有限，但根据 BD 分层，现代创伤后总体生存率相同。然而，生理功能严重紊乱的患者预后更好。BD 仍然是创伤后死亡率的一致预测因子。预测的生存率更多地取决于损伤的能量水平（刺伤 vs. 非刺伤），而不是损伤机制（钝性 vs. 穿透性）。
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