Allen Casey J, Valle Evan J, Jouria Jassin M, Schulman Carl I, Namias Nicholas, Livingstone Alan S, Proctor Kenneth G
From the Divisions of Trauma, Surgical Critical Care, Dewitt-Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida.
J Trauma Acute Care Surg. 2014 Dec;77(6):859-64; discussion 864. doi: 10.1097/TA.0000000000000422.
The purpose of this study was to test the hypothesis that a single bolus of 6% hydroxyethyl starch (HES 450/0.7 in lactated electrolyte injection) during initial resuscitation has a differential effect in blunt and penetrating trauma patients.
Consecutive admissions to the trauma service were reviewed. Patients who died within 24 hours were excluded. Multivariate analysis defined individual predictors for the primary outcomes, acute kidney injury (AKI) and mortality within 90 days. Data were expressed as mean ± SD, and significance was assessed at p < 0.05.
There were 1,410 patients (76% male; mean ± SD, age 43 ± 18 years; 68% blunt trauma; mean ± SD Injury Severity Score [ISS] 14 ± 11; AKI, 4.4%; and mortality, 3.4%). HES (0.5-1.5 L) was administered to 216 patients (15.3%). After multiple logistic regression, HES remained a significant independent predictor of AKI after blunt trauma (odds ratio [OR], 2.54; 95% confidence interval [CI], 1.24-5.19; area under the receiver operating characteristic curve [AUROC], 0.809) but not penetrating trauma (OR, 0.90; 95% CI, 0.23-3.60; AUROC, 0.849). In separate logistic regression models, HES was a significant predictor of mortality after blunt trauma (OR, 3.77; 95% CI, 0.91-0.97; AUROC, 0.921) but not penetrating trauma (OR, 0.72; 95% CI, 0.13-3.94; AUROC, 0.904).
HES is an independent risk factor for AKI and death after blunt, but not penetrating, trauma, which underscores a fundamental difference between these two injury types.
Epidemiologic study, level III.
本研究的目的是检验以下假设：在初始复苏期间单次推注6%羟乙基淀粉（乳酸电解质注射液中的HES 450/0.7）对钝性创伤和穿透性创伤患者有不同影响。
回顾创伤科连续收治的患者。排除24小时内死亡的患者。多变量分析确定了主要结局（急性肾损伤[AKI]和90天内死亡率）的个体预测因素。数据以均值±标准差表示，显著性评估为p<0.05。
共有1410例患者（76%为男性；均值±标准差，年龄43±18岁；68%为钝性创伤；均值±标准差损伤严重度评分[ISS]为14±11；AKI发生率为4.4%；死亡率为3.4%）。216例患者（15.3%）接受了HES（0.5 - 1.5L）治疗。经过多因素logistic回归分析，HES仍然是钝性创伤后AKI的显著独立预测因素（比值比[OR]为2.54；95%置信区间[CI]为1.24 - 5.19；受试者工作特征曲线下面积[AUROC]为0.809），但不是穿透性创伤的预测因素（OR为0.90；95%CI为0.23 - 3.60；AUROC为0.849）。在单独的logistic回归模型中，HES是钝性创伤后死亡率的显著预测因素（OR为3.77；95%CI为0.91 - 0.97；AUROC为0.921），但不是穿透性创伤的预测因素（OR为0.72；95%CI为0.13 - 3.94；AUROC为0.904）。
HES是钝性创伤而非穿透性创伤后AKI和死亡的独立危险因素，这突出了这两种损伤类型之间的根本差异。
流行病学研究，III级。
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