Vayer J S, Henderson J V, Bellamy R F, Galper A R
Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814-4799.
Ann Emerg Med. 1988 Mar;17(3):227-31. doi: 10.1016/s0196-0644(88)80111-2.
The belief that tachycardia is an early and reliable indicator of shock has recently been challenged. We examined 144 battlefield casualties with penetrating intraperitoneal injury to determine whether patients in shock presented with pulse rates that were significantly more rapid than those in patients not in shock. No differences in mean pulse rates were found when using objective operational definitions of shock. In contrast, the only pulse rate difference was noted when shock was defined on the basis of the surgeon's subjective clinical impression and this was attributed to selection bias. The absence of a tachycardic response in battlefield casualties with penetrating abdominal wounds cannot be taken as an indication that serious injury and significant intraperitoneal bleeding have not occurred. Caution should be exercised when using this parameter as a guide for therapeutic interventions, and further study is indicated to determine whether a similar pattern is seen in civilian practice.
心动过速是休克早期可靠指标这一观点近来受到了挑战。我们检查了144例穿透性腹腔损伤的战场伤员，以确定休克患者的脉搏率是否显著高于未休克患者。在使用休克的客观操作定义时，未发现平均脉搏率有差异。相比之下，当根据外科医生的主观临床印象定义休克时，仅发现了脉搏率差异，而这归因于选择偏倚。穿透性腹部伤口的战场伤员没有心动过速反应，不能就此表明未发生严重损伤和大量腹腔内出血。在将该参数用作治疗干预指导时应谨慎，并且需要进一步研究以确定在 civilian practice中是否也会出现类似情况。 （注：原文中“civilian practice”直译为“平民实践”，结合语境这里可能是指“非战场的临床实践”，但由于要求不添加解释，所以保留英文未译。）
