Asst. Prof. Dr., Department of Emergency Medicine, Bozok University Faculty of Medicine, Yozgat-Turkey.
Asst. Prof. Dr., Department of Cardiology, Bozok University Faculty of Medicine, Yozgat-Turkey.
Prehosp Disaster Med. 2021 Feb;36(1):67-73. doi: 10.1017/S1049023X20001338. Epub 2020 Nov 4.
The use of a long backboard and cervical collar are commonly recommended by international guidelines for spinal immobilization, but both devices may cause several side effects. In a recent study, it was reported that spinal immobilization at 20° eliminated the decrease in pulmonary function secondary to spinal immobilization performed at 0°. Spinal immobilization at 20° is a new recommendation, but other potential effects need to be explored before it can be implemented in clinical use.
Hemodynamic observation is important in the management of trauma patients. The aim of this study was to investigate the effect of spinal immobilization at a 20° position instead of 0° on hemodynamic parameters.
This study included 53 healthy volunteers who underwent spinal immobilization in the supine position (00) and in an elevated position (200). Systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate (HR), left ventricular outflow tract velocity time integral (LVOT-VTI), left ventricular stroke volume (LVSV), cardiac output (CO), inferior vena cava diameter inspiration (IVC diameter insp), IVC diameter expiration (IVC diameter exp), and inferior vena cava collapsibility index (IVC-CI) were measured at the 0th and 30th minutes of spinal immobilization in both positions. The data were compared for demonstrating the efficiency of both positions in spinal immobilization.
A statistically significant difference was found in the parameters of the IVC diameter (exp), IVC diameter (insp), LVOT-VTI, LVSV, and CO through the measurements starting in the 0th minute of the transition from 0° to 20° (P <.001). Delta values (∆) of hemodynamic parameters (∆IVC diameter [exp], ∆IVC diameter [insp], ∆LVOT-VTI, ∆SV, ∆CO, ∆IVC-CI, ∆MAP, ∆SAP, ∆DAP, and ∆HR) were similar in spinal immobilization at 0° and 20°.
The findings obtained from this study illustrate that spinal immobilization at 20° does not cause clinically significant hemodynamic changes in healthy subjects compared to spinal immobilization at 0°.
国际指南通常建议在脊柱固定时使用长背板和颈托，但这两种设备都可能引起多种副作用。最近的一项研究表明，与 0°时的脊柱固定相比，20°时的脊柱固定可消除因脊柱固定导致的肺功能下降。20°的脊柱固定是新的推荐方法，但在实际应用之前，需要进一步探索其他潜在影响。
血流动力学监测在创伤患者的管理中非常重要。本研究旨在探讨 20°脊柱固定位置代替 0°脊柱固定位置对血流动力学参数的影响。
本研究纳入了 53 名健康志愿者，他们分别接受仰卧位（0°）和抬高位（20°）下的脊柱固定。在这两种体位下，分别于脊柱固定的第 0 分钟和第 30 分钟测量收缩压（SAP）、舒张压（DAP）、平均动脉压（MAP）、心率（HR）、左心室流出道速度时间积分（LVOT-VTI）、左心室每搏量（LVSV）、心输出量（CO）、下腔静脉直径吸气（IVC 直径 insp）、下腔静脉直径呼气（IVC 直径 exp）和下腔静脉塌陷指数（IVC-CI）。比较两种体位下的脊柱固定效果。
从 0°转换到 20°的第 0 分钟开始测量时，下腔静脉直径（exp）、下腔静脉直径（insp）、LVOT-VTI、LVSV 和 CO 等参数均有显著统计学差异（P <.001）。0°和 20°脊柱固定时，血流动力学参数的差值（∆）（∆IVC 直径[exp]、∆IVC 直径[insp]、∆LVOT-VTI、∆SV、∆CO、∆IVC-CI、∆MAP、∆SAP、∆DAP 和 ∆HR）相似。
本研究结果表明，与 0°脊柱固定相比，20°脊柱固定在健康受试者中不会引起有临床意义的血流动力学变化。
