Department of Surgery,Section of Trauma and Critical Care Surgery, Tulane University Health Science Center, New Orleans, Louisiana 70112, USA.
J Trauma Acute Care Surg. 2012 Sep;73(3):674-8. doi: 10.1097/TA.0b013e318265ce1f.
Damage control resuscitation (DCR) conveys a survival advantage in patients with severe hemorrhage. The role of restrictive fluid resuscitation (RFR) when used in combination with DCR has not been elucidated. We hypothesize that RFR, when used with DCR, conveys an overall survival benefit for patients with severe hemorrhage.
This is a retrospective analysis from January 2007 to May 2011 at a Level I trauma center. Inclusion criteria included penetrating torso injuries, systolic blood pressure less than or equal to 90 mm Hg, and managed with DCR and damage control surgery (DCS). There were two groups according to the quantity of fluid before DCS: (1) standard fluid resuscitation (SFR) greater than or equal to 150 mL of crystalloid; (2) RFR less than 150 mL of crystalloid. Demographics and outcomes were analyzed.
Three hundred seven patients were included. Before DCS, 132 (43%) received less than 150 mL of crystalloids, grouped under RFR; and 175 (57%) received greater than or equal to 150 mL of crystalloids, grouped under SFR. Demographics and initial clinical characteristics were similar between the study groups. Compared with the SFR group, RFR patients received less fluid preoperatively (129 mL vs. 2,757 mL; p < 0.001), exhibited a lower intraoperative mortality (9% vs. 32%; p < 0.001), and had a shorter hospital length of stay (13 vs. 18 days; p = 0.02). Patients in the SFR group had a lower trauma intensive care unit mortality (5 vs. 12%; p = 0.03) but exhibited a higher overall mortality. Patients receiving RFR demonstrated a survival benefit, with an odds ratio for mortality of 0.69 (95% confidence interval, 0.37-0.91).
To the best of our knowledge, this is the first civilian study that analyzes the impact of RFR in patients managed with DCR. Its use in conjunction with DCR for hypotensive trauma patients with penetrating injuries to the torso conveys an overall and early intraoperative survival benefit.
Therapeutic study, level IV.
损伤控制性复苏（DCR）可使严重出血患者获得生存优势。联合使用限制性液体复苏（RFR）在 DCR 中的作用尚未阐明。我们假设，在严重出血患者中，与 DCR 联合使用 RFR 可带来整体生存获益。
这是在一个一级创伤中心进行的一项 2007 年 1 月至 2011 年 5 月的回顾性分析。纳入标准包括穿透性胸腹部损伤、收缩压≤90mmHg，并采用 DCR 和损伤控制性手术（DCS）治疗。根据 DCS 前液体量，患者分为两组：（1）标准液体复苏（SFR）≥150ml 晶体液；（2）RFR＜150ml 晶体液。分析了患者的人口统计学和结局数据。
共纳入 307 例患者。在 DCS 前，132 例（43%）患者接受了少于 150ml 的晶体液，归入 RFR 组；175 例（57%）患者接受了≥150ml 的晶体液，归入 SFR 组。两组患者的人口统计学和初始临床特征相似。与 SFR 组相比，RFR 组患者术前接受的液体量较少（129ml 比 2757ml；p＜0.001），术中死亡率较低（9%比 32%；p＜0.001），住院时间较短（13 天比 18 天；p=0.02）。SFR 组患者的创伤重症监护病房死亡率较低（5%比 12%；p=0.03），但总体死亡率较高。接受 RFR 的患者具有生存优势，死亡率的优势比为 0.69（95%置信区间，0.37-0.91）。
据我们所知，这是第一项分析限制性液体复苏在接受损伤控制性复苏治疗的患者中的影响的平民研究。在伴有穿透性胸腹部损伤的低血压创伤患者中，联合使用 DCR 和 RFR 可带来整体和早期术中生存获益。
治疗性研究，IV 级。
