Phoenix Children's Hospital.
Phoenix Children's Hospital.
J Pediatr Surg. 2021 Mar;56(3):500-505. doi: 10.1016/j.jpedsurg.2020.07.007. Epub 2020 Jul 12.
No prior studies have examined the outcomes of early vasopressor use in children sustaining blunt liver or spleen injury (BLSI).
A planned secondary analysis of vasopressor use from a 10-center, prospective study of 1004 children with BLSI. Inverse probability of treatment weighting (IPTW) was used to compare patients given vasopressors <48 h after injury to controls based on pretreatment factors. A logistic regression was utilized to assess survival associated with vasopressor initiation factors on mortality and nonoperative management (NOM) failure.
Of 1004 patients with BLSI, 128 patients were hypotensive in the Pediatric Trauma Center Emergency Department (ED); 65 total patients received vasopressors. Hypotension treated with vasopressors was associated with a sevenfold increase in mortality (AOR = 7.6 [p < 0.01]). When excluding patients first given vasopressors for cardiac arrest, the risk of mortality increased to 11-fold (AOR = 11.4 [p = 0.01]). All deaths in patients receiving vasopressors occurred when started within the first 12 h after injury. Vasopressor administration at any time was not associated with NOM failure.
After propensity matching, early vasopressor use for hypotension in the ED was associated with an increased risk of death, but did not increase the risk of failure of NOM.
Level III prognostic and epidemiological, prospective.
此前尚无研究探讨过钝性肝或脾损伤（BLSI）患儿早期使用血管加压药的结果。
对 1004 例 BLSI 患儿的 10 个中心前瞻性研究中使用血管加压药的情况进行了计划中的二次分析。根据治疗前的因素，采用逆概率治疗加权法（IPTW）比较损伤后<48 小时内使用血管加压药的患者与对照组。采用逻辑回归评估血管加压药启动因素与死亡率和非手术治疗（NOM）失败相关的生存情况。
在 1004 例 BLSI 患儿中，有 128 例在儿科创伤中心急诊室（ED）出现低血压；65 例患儿总共接受了血管加压药治疗。用血管加压药治疗低血压与死亡率增加七倍相关（AOR=7.6[P<0.01]）。当排除首先因心脏骤停而首次给予血管加压药的患者时，死亡率增加至 11 倍（AOR=11.4[P=0.01]）。所有接受血管加压药治疗的患者的死亡均发生在受伤后 12 小时内开始时。在任何时候使用血管加压药均与 NOM 失败无关。
经过倾向评分匹配后，ED 中低血压早期使用血管加压药与死亡风险增加相关，但不会增加 NOM 失败的风险。
III 级预后和流行病学，前瞻性。
