Department of Anaesthesiology and Critical Care, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord-Val-De-Seine, Assistance Publique-Hôpitaux de Paris (AP-HP), Clichy, France.
Department of Anaesthesiology and Critical Care, Hôpital Saint Louis-Lariboisière, AP-HP, Paris, France.
Br J Anaesth. 2018 Jun;120(6):1237-1244. doi: 10.1016/j.bja.2018.02.032. Epub 2018 Apr 14.
The role of vasopressors in trauma-related haemorrhagic shock (HS) remains a matter of debate. They are part of the most recent European recommendations on the management of HS and are regularly used in France. We assessed the effect of early administration of noradrenaline in 24 h mortality of trauma patients in HS, using a propensity-score analysis.
The study included patients from a multicentre prospective regional trauma registry. HS was defined as transfusion of ≥4 erythrocyte-concentrate units during the first 6 h. Patients with a Glasgow coma scale=3 and pre-hospital traumatic cardiac arrest were excluded. The main outcome measure was in-hospital mortality. The explicative and adjustment variables for the outcome and treatment allocation were predetermined by a Delphi method. The in-hospital mortality of patients with and without early administration of noradrenaline was compared in a propensity-score model, including all predetermined variables.
Of 7141 patients in the registry in the study period, 6353 were screened and 518 patients in HS (201 with early noradrenaline use and 317 without) were included and analysed. After propensity-score matching, 100 patients remained in each group, and the hazard-ratio mortality was 0.95 (95% confidence interval: 0.45-2.01; P=0.69).
The results of the present study suggest that noradrenaline use in the early phase of traumatic HS does not seem to affect mortality adversely. This observation supports a rationale for equipoise in favour of a prospective trial of the use of vasopressors in HS after trauma.
加压素在创伤相关失血性休克（HS）中的作用仍存在争议。它是最近关于 HS 管理的欧洲建议的一部分，在法国经常使用。我们使用倾向评分分析评估早期给予去甲肾上腺素对 HS 创伤患者 24 小时死亡率的影响。
这项研究纳入了来自一个多中心前瞻性区域创伤登记处的患者。HS 的定义为在前 6 小时内输注≥4 单位红细胞浓缩物。格拉斯哥昏迷量表=3 和院前创伤性心脏骤停的患者被排除在外。主要观察指标是院内死亡率。通过 Delphi 方法预先确定了结局和治疗分配的解释性和调整变量。在倾向评分模型中比较了接受和未接受早期去甲肾上腺素治疗的患者的院内死亡率，该模型包括所有预定变量。
在研究期间，登记处共有 7141 例患者，筛选出 6353 例，其中 518 例 HS（201 例早期使用去甲肾上腺素，317 例未使用）患者纳入并进行分析。经过倾向评分匹配后，每组仍有 100 例患者，死亡率的风险比为 0.95（95%置信区间：0.45-2.01；P=0.69）。
本研究的结果表明，去甲肾上腺素在创伤性 HS 的早期使用似乎不会对死亡率产生不利影响。这一观察结果支持了在创伤后使用血管加压素的前瞻性试验中平衡使用的合理性。
