Ko Ara, Harada Megan Y, Barmparas Galinos, Smith Eric J T, Birch Kurtis, Barnard Zachary R, Yim Dorothy A, Ley Eric J
Am Surg. 2017 Dec 1;83(12):1447-1452.
Patients with traumatic brain injury (TBI) are often resuscitated with crystalloids in the emergency department (ED) to maintain cerebral perfusion. The purpose of this study was to evaluate whether crystalloid resuscitation volume impacts mortality in TBI patients. This was a retrospective study of trauma patients with head abbreviated injury scale score ≥2, who received crystalloids during ED resuscitation between 2004 and 2013. Clinical characteristics and volume of crystalloids received in the ED were collected. Patients who received <2 L of crystalloids were categorized as low volume (LOW), whereas those who received ≥2 L were considered high volume (HIGH). Mortality and outcomes were compared. Multivariable regression analysis was used to determine the odds of mortality while controlling for confounders. Over 10 years, 875 patients met inclusion criteria. Overall mortality was 12.5 per cent. Seven hundred and forty-two (85%) were in the LOW cohort and 133 (15%) in the HIGH cohort. Gender and age were similar between the groups. The HIGH cohort had lower admission systolic blood pressure (128 vs 138 mm Hg, P = 0.001), lower Glasgow coma scale score (10 vs 12, P < 0.001), higher head abbreviated injury scale (3.8 vs 3.3, P < 0.001), and higher injury severity score (25 vs 18, P < 0.001). The LOW group had a lower unadjusted mortality (10 vs 26%, P < 0.001). Multivariable analysis adjusting for confounders demonstrated that those resuscitated with ≥2 L of crystalloids had increased odds of mortality (adjusted odds ratio 2.25, P = 0.005). Higher volume crystalloid resuscitation after TBI is associated with increased mortality, thus limited resuscitation for TBI patients may be indicated.
创伤性脑损伤（TBI）患者在急诊科（ED）常接受晶体液复苏以维持脑灌注。本研究的目的是评估晶体液复苏量是否会影响TBI患者的死亡率。这是一项对2004年至2013年间在ED复苏期间接受晶体液治疗、头部简略损伤量表评分≥2的创伤患者的回顾性研究。收集了患者的临床特征和在ED接受的晶体液量。接受晶体液量<2L的患者被归类为低容量组（LOW），而接受量≥2L的患者被视为高容量组（HIGH）。比较了死亡率和结局。采用多变量回归分析来确定在控制混杂因素的情况下的死亡几率。在10多年间，875例患者符合纳入标准。总体死亡率为12.5%。低容量组有742例（85%），高容量组有133例（15%）。两组间性别和年龄相似。高容量组入院时收缩压较低（128 vs 138 mmHg，P = 0.001），格拉斯哥昏迷量表评分较低（10 vs 12，P < 0.001），头部简略损伤量表较高（3.8 vs 3.3，P < 0.001），损伤严重程度评分较高（25 vs 18，P < 0.001）。低容量组未经调整的死亡率较低（10% vs 26%，P < 0.001）。对混杂因素进行调整的多变量分析表明，接受≥2L晶体液复苏的患者死亡几率增加（调整后的优势比为2.25，P = 0.005）。TBI后较高容量的晶体液复苏与死亡率增加相关，因此可能需要对TBI患者进行限制性复苏。
