Li Yang, Zhang Lian-yang, Wang Yi, Zhang Wei-guo
State Key Laboratory of Trauma, Burns and Combined Injury, Trauma Center, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China.
J Emerg Med. 2013 Dec;45(6):872-8. doi: 10.1016/j.jemermed.2013.04.036. Epub 2013 Aug 9.
Computed tomography (CT) signs of hypovolemic shock have been reported previously. Whether these signs can be used to clinically predict hypovolemic shock remains unclear.
To investigate the predictive value of CT signs for hypovolemic shock in severe multiple-injury patients.
The clinical and multi-slice spiral CT (MSCT) data from 63 severe multiple-injury patients admitted to our trauma center from January 2008 to December 2011 were reviewed. The caliber of the inferior vena cava (IVC) and abdominal aorta, and mean CT value of the abdominal organs in both the early and the delayed phases were measured. The patients were divided into two groups, a shock group (n = 34) and a stable group (n = 29), based on the occurrence of hypovolemic shock within 24 h after the CT scan. Receiver operating characteristic curve (ROC) analysis was performed to assess the predictive accuracy of these signs for hypovolemic shock.
The shock group, compared to the stable group, had a higher Injury Severity Score (30 ± 8 vs. 22 ± 6, respectively, p < 0.001), shock index (1.17 ± 0.37 vs. 0.96 ± 0.33, respectively, p = 0.019), and lactate level (3.27 ± 0.69 mmol/L vs. 2.56 ± 0.89 mmol/L, respectively, p = 0.001). Among all the CT signs, the flatness index of IVC had the largest area under the curve (0.833) in ROC analysis, with sensitivity of 73.5% and specificity of 86.2%, higher than traditional indices and other CT signs. The optimal diagnostic cutoff value for the flatness index of IVC was 3.02.
MSCT can provide useful information for predicting hyovolemic shock in severe multiple-injury patients. An IVC flatness index > 3.02 suggests the presence of hypovolemic shock in severe multiple-injury patients.
此前已有关于低血容量性休克的计算机断层扫描（CT）征象的报道。这些征象是否可用于临床预测低血容量性休克仍不清楚。
探讨CT征象对严重多发伤患者低血容量性休克的预测价值。
回顾了2008年1月至2011年12月期间入住我院创伤中心的63例严重多发伤患者的临床资料和多层螺旋CT（MSCT）数据。测量了下腔静脉（IVC）和腹主动脉的管径，以及早期和延迟期腹部器官的平均CT值。根据CT扫描后24小时内是否发生低血容量性休克，将患者分为两组，休克组（n = 34）和稳定组（n = 29）。采用受试者操作特征曲线（ROC）分析评估这些征象对低血容量性休克的预测准确性。
与稳定组相比，休克组的损伤严重度评分更高（分别为30±8和22±6，p < 0.001）、休克指数更高（分别为1.17±0.37和0.96±0.33，p = 0.019）以及乳酸水平更高（分别为3.27±0.69 mmol/L和2.56±0.89 mmol/L，p = 0.001）。在所有CT征象中，IVC扁平指数在ROC分析中的曲线下面积最大（0.833），敏感性为73.5%，特异性为86.2%，高于传统指标和其他CT征象。IVC扁平指数的最佳诊断截断值为3.02。
MSCT可为预测严重多发伤患者的低血容量性休克提供有用信息。IVC扁平指数> 3.02提示严重多发伤患者存在低血容量性休克。
