Snyder H S
Department of Emergency Medicine, Albany Medical Center Hospital, NY 12208.
Am J Emerg Med. 1990 Jan;8(1):23-6. doi: 10.1016/0735-6757(90)90288-b.
The concept that tachycardia is a reliable indicator of shock has recently been challenged in patients with hemoperitoneum. The purpose of this study was to document whether patients with ruptured ectopic pregnancy manifest a tachycardic response to hypotension and to define the relationship between hemodynamic response and blood loss resulting from hemoperitoneum. A retrospective chart review of 154 patients with documented ectopic pregnancy identified 20 (13.0%) hypotensive patients (systolic blood pressure less than or equal to 90 mm Hg). Eleven (55%) patients were not tachycardic (pulse rate less than 100 beats/min) and nine (45%) patients were tachycardic. The quantity of hemoperitoneum varied widely in each group and did not correlate with the hemodynamic response. These results support the proposed theory that hemoperitoneum may trigger a parasympathetic reflex, resulting in a pulse rate inappropriate for the degree of hypotension. A vasovagal reflex may play a role in those patients without significant hemoperitoneum. The diagnosis of hypovolemic shock must be considered when hypotension is present without tachycardia.
近期，心动过速是休克可靠指标这一概念在腹腔积血患者中受到了挑战。本研究旨在记录异位妊娠破裂患者是否会对低血压表现出心动过速反应，并确定血流动力学反应与腹腔积血导致的失血之间的关系。对154例有记录的异位妊娠患者进行回顾性病历审查，确定了20例（13.0%）低血压患者（收缩压小于或等于90毫米汞柱）。11例（55%）患者无心动过速（心率小于100次/分钟），9例（45%）患者有心动过速。每组腹腔积血量差异很大，且与血流动力学反应无关。这些结果支持了以下理论：腹腔积血可能引发副交感神经反射，导致心率与低血压程度不相称。血管迷走反射可能在那些腹腔积血不严重的患者中起作用。当出现低血压且无心动过速时，必须考虑低血容量性休克的诊断。
