McKinley Todd O, McCarroll Tyler, Gaski Greg E, Frantz Travis L, Zarzaur Ben L, Terry Colin, Steenburg Scott D
*Department of Orthopaedic Surgery, Indiana University School of Medicine, IU Health Methodist Hospital †Indiana University School of Medicine, Indianapolis, Indiana ‡Department of Orthopaedic Surgery, The Ohio State University Hospital, Columbus, Ohio §Department of Surgery and Center for Outcomes Research in Surgery, Indiana University School of Medicine, IU Health Methodist Hospital ||Methodist Research Institute ¶Department of Radiology and Imaging Sciences, Indiana University School of Medicine, IU Health Methodist Hospital, Indianapolis, Indiana.
Shock. 2016 Feb;45(2):126-32. doi: 10.1097/SHK.0000000000000501.
Multiply injured patients (MIPs) in hemorrhagic shock develop oxygen debt which causes organ dysfunction and can lead to death. We developed a noninvasive patient-specific index, Shock Volume (SV), to quantify the magnitude of hypoperfusion. SV integrates the magnitude and duration that incremental shock index values are elevated above known thresholds of hypoperfusion using serial individual vital sign data. SV can be monitored in real time to assess ongoing hypoperfusion. The goal of this study was to determine how SV corresponded to transfusion requirements and organ dysfunction in a retrospective cohort of 74 MIPs. We measured SV in 6-h increments for 48 h after injury in multiply injured adults (18-65; Injury Severity Score ≥18). Patients who had accumulated 40 units of SV within 6 h of injury and 100 units of SV within 12 h of injury were at high risk for requiring massive transfusion or multiple critical administration transfusions. SV measurements were equally sensitive and specific as compared with base deficit values in predicting transfusions. SV measurements at 6 h after injury stratified patients at risk for multiple organ failure determined by Denver scores. In addition, SV values corresponded to the magnitude of organ failure determined by Sequential Organ Failure Assessment scores. SV is a patient-specific index that can be quantified in real time in critically injured patients. It is a surrogate for cumulative hypoperfusion and it predicts high-volume transfusions and organ dysfunction.
出血性休克的多发伤患者会出现氧债，进而导致器官功能障碍并可能致死。我们开发了一种针对患者的无创指标——休克量（SV），以量化低灌注的程度。SV利用连续的个体生命体征数据，整合了休克指数增量值高于已知低灌注阈值的程度和持续时间。SV可实时监测，以评估持续的低灌注情况。本研究的目的是在一个包含74例多发伤患者的回顾性队列中，确定SV与输血需求及器官功能障碍之间的关系。我们对成年多发伤患者（18 - 65岁；损伤严重度评分≥18）受伤后48小时内每6小时测量一次SV。在受伤后6小时内累积40个单位SV以及在受伤后12小时内累积100个单位SV的患者，有大量输血或多次紧急输注的高风险。与碱缺失值相比，SV测量在预测输血方面具有同等的敏感性和特异性。受伤后6小时的SV测量对丹佛评分确定的多器官功能衰竭风险患者进行了分层。此外，SV值与序贯器官衰竭评估评分确定的器官衰竭程度相对应。SV是一种针对患者的指标，可在重症受伤患者中实时量化。它是累积低灌注的替代指标，可预测大量输血和器官功能障碍。
