Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany.
Department of Orthopedics and Trauma Surgery, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany.
Eur J Trauma Emerg Surg. 2023 Feb;49(1):217-225. doi: 10.1007/s00068-022-02051-5. Epub 2022 Aug 3.
During resuscitation of patients with severe trauma, guidelines recommend permissive hypotension prior to surgical bleeding control. However, hypotension may be associated with reduced organ perfusion and multiple organ dysfunction, e.g. myocardial injury. The association between hypotension and myocardial injury in trauma patients is underexplored. We hypothesized that hypotension is associated with myocardial injury in this population.
This retrospective study included patients ≥ 18 years suffering from severe trauma [defined as Injury Severity Score (ISS) ≥ 16] that were treated in the emergency department resuscitation room between 2016 and 2019. Primary endpoint was the incidence of myocardial injury defined as high-sensitive troponin T > 14 ng/l. Main exposure was the duration of arterial hypotension during resuscitation period defined as mean arterial pressure < 65 mmHg.
Out of 368 patients screened, 343 were analyzed (73% male, age: 55 ± 21, ISS: 28 ± 12). Myocardial injury was detected in 143 (42%) patients. Overall in-hospital mortality was 26%. Multivariate binary logistic regression with forced entry of nine predefined covariables revealed an odds ratio of 1.29 [95% confidence interval 1.16-1.44]; p = 0.012) for the association between the duration of hypotension and myocardial injury.
The duration of hypotension during resuscitation period is independently associated with the incidence of myocardial injury in patients with severe trauma.
在严重创伤患者的复苏过程中，指南建议在进行外科出血控制之前允许低血压。然而，低血压可能与器官灌注减少和多器官功能障碍有关，例如心肌损伤。在创伤患者中，低血压与心肌损伤之间的关系尚未得到充分探讨。我们假设在该人群中，低血压与心肌损伤有关。
本回顾性研究纳入了 2016 年至 2019 年期间在急诊科复苏室接受治疗的年龄≥18 岁的严重创伤患者[定义为损伤严重程度评分（ISS）≥16]。主要终点是心肌损伤的发生率，定义为高敏肌钙蛋白 T＞14ng/l。主要暴露是复苏期间动脉低血压的持续时间，定义为平均动脉压＜65mmHg。
在筛选出的 368 名患者中，343 名患者被纳入分析（73%为男性，年龄：55±21 岁，ISS：28±12）。143 名（42%）患者检测到心肌损伤。总住院死亡率为 26%。多元二项逻辑回归分析，强制纳入 9 个预先定义的协变量，显示低血压持续时间与心肌损伤之间的比值比为 1.29（95%置信区间 1.16-1.44）；p=0.012）。
在严重创伤患者的复苏过程中，低血压持续时间与心肌损伤的发生率独立相关。
