Spinal Unit, The Princess Alexandra Hospital, University of Queensland, Brisbane, Queensland, Australia.
Spinal Unit, The Princess Alexandra Hospital, University of Queensland, Brisbane, Queensland, Australia.
World Neurosurg. 2019 Aug;128:e225-e230. doi: 10.1016/j.wneu.2019.04.106. Epub 2019 May 25.
The American Association and Congress of Neurological Surgeons recommended mean arterial blood pressure (MAP) in patients with acute spinal cord injury (SCI) should be 85-90 mm Hg for the first 7 days. We evaluated whether hemodynamic management differed between a primary-receiving and tertiary hospital in the first 24 hours for patients with acute SCI and assessed whether use of a checklist could improve hemodynamic management.
Observational review was performed of 79 patients with acute SCI before and after introduction of a blood pressure monitoring checklist and staff educational program designed to improve tertiary center management. Hemodynamic management in the primary-receiving hospital was compared with the tertiary center before and after checklist introduction.
At the primary-receiving center, mean number of documented MAP readings/hour was 2.2 and 3 before and after checklist introduction. The proportion having >50% of MAP recordings <80 mm Hg was 26% and 22%. The proportion having >50% of MAP recordings <70 mm Hg was 8.5% and 7%. At the tertiary center, mean number of MAP readings/hour was 1.3 and 2.7 before and after checklist introduction (P = 0.02). The proportion having >50% of MAP recordings <80 mm Hg decreased from 36.5% to 16% after checklist introduction (P = 0.05). The proportion having >50% of MAP recordings <70 mm Hg decreased from 9% to 5.5% (P = 0.6). Polytrauma, inotrope use, and head injury significantly correlated with low MAP recordings (P < 0.05). Polytrauma was an independent risk predictor for low MAP recordings (P < 0.05).
Achieving MAP targets for patients with acute SCI is challenging. Checklist use and staff education were associated with improved hemodynamic management. Presence of polytrauma identified patients at particular risk.
美国神经外科学会建议急性脊髓损伤（SCI）患者的平均动脉压（MAP）在最初 7 天内应保持在 85-90mmHg。我们评估了在急性 SCI 患者中，初级接收医院和三级医院在最初 24 小时内的血流动力学管理是否存在差异，并评估了使用检查表是否可以改善血流动力学管理。
对 79 例急性 SCI 患者在引入血压监测检查表和旨在提高三级中心管理的员工教育计划前后进行了观察性回顾。在检查表引入前后，比较了初级接收医院和三级中心的血流动力学管理。
在初级接收医院，记录 MAP 读数/小时的平均数量分别为检查表引入前后的 2.2 和 3。MAP 记录<80mmHg 的比例分别为 26%和 22%。MAP 记录<70mmHg 的比例分别为 8.5%和 7%。在三级中心，MAP 读数/小时的平均数量分别为检查表引入前后的 1.3 和 2.7（P=0.02）。MAP 记录<80mmHg 的比例从检查表引入前的 36.5%降至 16%（P=0.05）。MAP 记录<70mmHg 的比例从 9%降至 5.5%（P=0.6）。多发伤、儿茶酚胺类药物的使用和头部损伤与 MAP 读数低显著相关（P<0.05）。多发伤是 MAP 读数低的独立危险因素（P<0.05）。
实现急性 SCI 患者的 MAP 目标具有挑战性。检查表的使用和员工教育与改善血流动力学管理相关。多发伤确定了具有特定风险的患者。
