Li Yan-ling, Chan Cangel Pui-yee, Sin King-keung, Chan Stewart S W, Lin Pei-yi, Chen Xiao-hui, Smith Brendan E, Joynt Gavin M, Graham Colin A, Rainer Timothy H
Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Hong Kong, China; Emergency Department, The Second Affiliated Hospital of Guangzhou Medical University, China.
Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Hong Kong, China.
Am J Emerg Med. 2014 Nov;32(11):1345-50. doi: 10.1016/j.ajem.2014.08.029. Epub 2014 Aug 21.
The importance of the early recognition of shock in patients presenting to emergency departments is well recognized, but at present, there is no agreed practical definition for undifferentiated shock. The main aim of this study was to validate an a priori clinical definition of shock against 28-day mortality.
DESIGN, SETTING AND SUBJECTS: This prospective, observational, cross-sectional, single-center study was conducted in Hong Kong, China. Data were collected between July 1, 2012, and January 31, 2013. An a priori definition of shock was designed, whereby patients admitted to the resuscitation room or high dependency area of the emergency department were divided into 1 of 3 groups-no shock, possible shock, and shock. The primary outcome was 28-day mortality. Secondary outcomes were in-hospital mortality or admission to the intensive or coronary care unit.
A total of 111 patients (mean age, 67.2 ± 17.1 years; male = 69 [62%]) were recruited, of which 22 were classified as no shock, 54 as possible shock, and 35 as shock. Systolic blood pressure, mean arterial pressure, lactate, and base deficit correlated well with shock classifications (P < .05). Patients who had 3 or more positively defined shock variables had a 100% poor composite outcome rate (5 of 5). Patients with 2 shock variables had a 66.7% (4 of 6) poor composite outcome rate.
A simple, practical definition of undifferentiated shock has been proposed and validated in a group of patients presenting to an emergency department in Hong Kong. This definition needs further validation in a larger population and other settings.
急诊科患者休克的早期识别至关重要，这一点已得到广泛认可，但目前对于未分化休克尚无公认的实用定义。本研究的主要目的是针对28天死亡率验证休克的先验临床定义。
设计、设置与研究对象：本前瞻性、观察性、横断面、单中心研究在中国香港进行。数据收集时间为2012年7月1日至2013年1月31日。设计了休克的先验定义，据此将入住急诊科复苏室或高依赖区的患者分为3组之一——无休克、可能休克和休克。主要结局为28天死亡率。次要结局为住院死亡率或入住重症监护病房或冠心病监护病房。
共纳入111例患者（平均年龄67.2±17.1岁；男性69例[62%]），其中22例分类为无休克，54例为可能休克，35例为休克。收缩压、平均动脉压、乳酸和碱缺失与休克分类相关性良好（P<0.05）。具有3个或更多阳性定义的休克变量的患者不良复合结局率为100%（5/5）。具有2个休克变量的患者不良复合结局率为66.7%（4/6）。
已在一组香港急诊科就诊患者中提出并验证了未分化休克的简单实用定义。该定义需要在更大规模人群和其他环境中进一步验证。
