急性脊髓损伤的血压管理：对新南威尔士州两个转诊中心创伤性脊髓损伤急性重症监护管理的回顾性研究。

Blood pressure management in acute spinal cord injury: A retrospective study of acute intensive care management of traumatic spinal cord injury in two New South Wales referral centres.

作者信息

Garside Tessa, Stanford Ralph, Flower Oliver, Li Trent, Dababneh Edward, Hammond Naomi, Bass Frances, Middleton James, Tang Jonathan, Ball Jonathan, Delaney Anthony

机构信息

Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Australia; The George Institute for Global Health, Australia; University of Sydney, Australia.

Department of Orthopaedic Surgery, Prince of Wales Hospital, Australia; Neuroscience Research Australia, Prince of Wales Hospital, Australia.

出版信息

Aust Crit Care. 2025 Mar;38(2):101131. doi: 10.1016/j.aucc.2024.09.016. Epub 2024 Nov 16.

DOI:10.1016/j.aucc.2024.09.016

PMID:39550336

Abstract

BACKGROUND

International guidelines recommend maintenance of mean arterial pressure (MAP) > 85 mmHg to defend spinal cord perfusion pressure after acute traumatic spinal cord injury (SCI). Variation in practice has been demonstrated in the emergency department blood pressure management of SCI in New South Wales (NSW). It is unknown whether this variation exists in the phase of intensive care management of acute SCI.

OBJECTIVES

The objective of this study was to describe and compare current blood pressure management in the intensive care unit (ICU) of patients with acute traumatic SCI in two SCI referral centres in NSW.

METHODS

Patients with acute traumatic SCI admitted to two SCI referral centres, Unit A and Unit B during 2018-2019 in NSW, were included. Data were summarised using descriptive statistics.

RESULTS

Ninety-eight patients were included, with 91 patients having been prescribed a blood pressure target, 81 (83%) having required vasopressors, and 18 (18%) of these having been documented to have complications associated with vasopressor use. The average prescribed MAP target was 78 (interquartile range [IQR]: 10) mmHg in Unit A and 76 (IQR: 12) mmHg in Unit B. Median durations of prescribed target were 120 (IQR: 72) hours and 120 (IQR: 120) hours in Unit A and Unit B, respectively. The average MAP over the first 7 d was 88 (standard deviation: 9.5) mmHg in Unit A and 85 (standard deviation: 7.5) mmHg in Unit B. Sixty-three patients (64%) had a documented systolic blood pressure <90 mmHg in the first 24 h. Median ICU length of stay (LOS) was 9.7 (IQR: 11) d in Unit A and 6 (IQR: 6.6) d in Unit B. Median hospital LOS was 27 (IQR: 56.2) d in Unit B and 34.7 (IQR: 32.3) d in Unit B. ICU LOS was longer in patients who had a MAP target than in those who did not.

CONCLUSIONS

Current blood pressure management in acute SCI in NSW involves ICU admission and blood pressure support with vasopressors; however, prescribed blood pressure targets are not in line with international guidelines.

摘要

背景

国际指南建议，急性创伤性脊髓损伤（SCI）后应维持平均动脉压（MAP）>85 mmHg，以保护脊髓灌注压。新南威尔士州（NSW）急诊科对SCI患者的血压管理存在实践差异。目前尚不清楚这种差异在急性SCI的重症监护管理阶段是否存在。

目的

本研究的目的是描述和比较新南威尔士州两个SCI转诊中心急性创伤性SCI患者在重症监护病房（ICU）的当前血压管理情况。

方法

纳入2018 - 2019年期间在新南威尔士州两个SCI转诊中心A单位和B单位收治的急性创伤性SCI患者。数据采用描述性统计进行汇总。

结果

共纳入98例患者，其中91例患者被设定了血压目标，81例（83%）需要使用血管升压药，其中18例（18%）有与使用血管升压药相关的并发症记录。A单位规定的平均MAP目标为78（四分位间距[IQR]：10）mmHg，B单位为76（IQR：12）mmHg。A单位和B单位规定目标的中位持续时间分别为120（IQR：72）小时和120（IQR：120）小时。A单位前7天的平均MAP为88（标准差：9.5）mmHg，B单位为85（标准差：7.5）mmHg。63例患者（64%）在最初24小时内记录的收缩压<90 mmHg。A单位ICU住院时间（LOS）中位数为9.7（IQR：11）天，B单位为6（IQR：6.6）天。A单位医院住院时间中位数为27（IQR：56.2）天，B单位为34.7（IQR：32.3）天。有MAP目标的患者ICU住院时间比没有目标的患者更长。