Lilitsis Emmanuel, Xenaki Sofia, Athanasakis Elias, Papadakis Eleftherios, Syrogianni Pavlina, Chalkiadakis George, Chrysos Emmanuel
Department of Anesthesiology, University Hospital of Crete, Heraklion, Greece.
Department of General Surgery, University Hospital of Crete, Heraklion, Greece.
J Emerg Trauma Shock. 2018 Apr-Jun;11(2):80-87. doi: 10.4103/JETS.JETS_74_17.
Trauma is one of the leading causes of death worldwide, with road traffic collisions, suicides, and homicides accounting for the majority of injury-related deaths. Since trauma mainly affects young age groups, it is recognized as a serious social and economic threat, as annually, almost 16,000 posttrauma individuals are expected to lose their lives and many more to end up disabled. The purpose of this research is to summarize current knowledge on factors predicting outcome - specifically mortality risk - in severely injured patients. Development of this review was mainly based on the systematic search of PubMed medical library, Cochrane database, and advanced trauma life support Guiding Manuals. The research was based on publications between 1994 and 2016. Although hypovolemic, obstructive, cardiogenic, and septic shock can all be seen in multi-trauma patients, hemorrhage-induced shock is by far the most common cause of shock. In this review, we summarize current knowledge on factors predicting outcome - more specifically mortality risk - in severely injured patients. The main mortality-predicting factors in trauma patients are those associated with basic human physiology and tissue perfusion status, coagulation adequacy, and resuscitation requirements. On the contrary, advanced age and the presence of comorbidities predispose patients to a poor outcome because of the loss of physiological reserves. Trauma resuscitation teams considering mortality prediction factors can not only guide resuscitation but also identify patients with high mortality risk who were previously considered less severely injured.
创伤是全球主要死因之一，道路交通事故、自杀和他杀占与伤害相关死亡的大部分。由于创伤主要影响年轻人群体，它被视为一种严重的社会和经济威胁，因为每年预计有近16000名创伤后患者死亡，更多的人最终致残。本研究的目的是总结目前关于预测重伤患者结局——特别是死亡风险——的因素的知识。本综述的撰写主要基于对PubMed医学图书馆、Cochrane数据库和高级创伤生命支持指南手册的系统检索。该研究基于1994年至2016年期间的出版物。虽然低血容量性、梗阻性、心源性和感染性休克在多发伤患者中均可见，但出血性休克是迄今为止最常见的休克原因。在本综述中，我们总结了目前关于预测重伤患者结局——更具体地说是死亡风险——的因素的知识。创伤患者主要的死亡预测因素是那些与人体基本生理和组织灌注状态、凝血充分性以及复苏需求相关的因素。相反，高龄和合并症的存在会使患者因生理储备的丧失而预后不良。考虑死亡预测因素的创伤复苏团队不仅可以指导复苏，还可以识别那些以前被认为受伤不太严重但死亡风险高的患者。
