Singla Anurag, Kaur Satinder, Kaur Navjot, Gill C S
Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Department of Biochemistry, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Int J Appl Basic Med Res. 2016 Oct-Dec;6(4):255-257. doi: 10.4103/2229-516X.192601.
In blunt trauma, extent of hemorrhage cannot be determined by physical examination, and vital signs may also not give clear picture in all the patients, especially young healthy ones. Hemorrhagic shock has been reported to increase blood ammonia levels. Arterial ammonia was analyzed in blunt trauma abdomen patients and correlated with shock index (SI). Its predictive value was determined for timely decision of intervention.
Hundred blunt trauma abdomen patients presented in the emergency ward of tertiary care hospital were included in the study. Group I comprised 62 patients requiring either blood transfusion ≥2 units and/or intervention to control bleeding within 24 h following admission. Group II had 38 patients: Not requiring transfusion/intervention during hospital stay. Arterial blood sample was taken immediately after admission; ammonia was analyzed within 20 min of sampling on Cobas 6000 (Roche). SI was calculated. Predictive value of ammonia was determined using receiver operating characteristic curve.
Ammonia levels and SI were significantly ( < 0.001) higher in Group I compared to Group II patients (68.55 ± 14.36 umol/L vs. 37.55 ± 7.41 umol/L and 1.28 ± 0.5 vs. 0.74 ± 0.12, respectively). Significantly higher number of patients in Group I (88.7% vs. 13%) had SI > 0.9. Ammonia levels were significantly higher in patients with complications and in those expired.
Ammonia levels were significantly higher in patients requiring blood transfusion/intervention in 24 h of admission. The best cutoff value to maximize sensitivity and specificity was ammonia >58.85 μmol/L. Ammonia estimation at admission can be clinically significant indicator of traumatic hemorrhage needing intervention.
在钝性创伤中，无法通过体格检查确定出血程度，生命体征在所有患者中也可能不清晰，尤其是年轻健康者。据报道，失血性休克会增加血氨水平。对钝性创伤腹部患者的动脉血氨进行分析，并与休克指数（SI）相关联。确定其预测价值以指导及时的干预决策。
纳入在三级医院急诊科就诊的100例钝性创伤腹部患者。第一组包括62例患者，这些患者在入院后24小时内需要输注≥2单位血液和/或进行干预以控制出血。第二组有38例患者：住院期间不需要输血/干预。入院后立即采集动脉血样本；在Cobas 6000（罗氏）上采样后20分钟内分析血氨。计算休克指数。使用受试者工作特征曲线确定血氨的预测价值。
与第二组患者相比，第一组患者的血氨水平和休克指数显著更高（分别为68.55±14.36 μmol/L对37.55±7.41 μmol/L和1.28±0.5对0.74±0.12，P<0.001）。第一组中休克指数>0.9的患者数量显著更多（88.7%对13%）。并发症患者和死亡患者的血氨水平显著更高。
入院后24小时内需要输血/干预的患者血氨水平显著更高。使敏感性和特异性最大化的最佳临界值是血氨>58.85 μmol/L。入院时血氨测定可作为需要干预的创伤性出血的重要临床指标。
