Tortella B J, Lavery R F, Rekant M
New Jersey Medical School, Newark, USA.
Acad Emerg Med. 1995 Mar;2(3):190-4. doi: 10.1111/j.1553-2712.1995.tb03194.x.
To determine the frequency of abnormal serum chemistries and whether they provide clinically useful information regarding trauma patients. To identify clinical criteria associated with critical serum chemistry values (CSCVs).
The records of all trauma patients admitted to one urban, Level I Trauma Center were retrospectively reviewed for the period (July 1-December 31, 1989). All trauma patients who had had serum chemistry determinations at hospital admission and at least once more prior to discharge were studied. The CSCVs were determined by a panel of experts prior to record review. Serum chemistry values, patient demographics, mechanisms of injury, and outcomes were statistically analyzed.
Most (814/913; 89%) trauma patients had abnormal serum chemistry values. However, only 54/913 (6%) had CSCVs and only six of these CSCVs had prompted a change in resuscitation or treatment (therapeutic K+ infusions). Age > 50 years, a history of hypertension therapy, and a Glasgow Coma Scale score < or = 10 were associated with CSCVs; and CSCVs were correlated with increased mortality and critical care unit admission.
Routine-admission serum chemistry values, while frequently abnormal for major trauma patients, generally do not provide clinically useful information in the resuscitation and treatment of trauma patients. Hypoglycemia and metabolic acidosis were more rapidly determined using bedside glucose determination and arterial blood gas evaluation. The routine-admission serum chemistry panel described in the study lacked utility for most trauma patients. Selective chemistry panel ordering should be used at the time of hospital admission for major trauma patients.
确定血清化学指标异常的频率，以及这些指标是否能为创伤患者提供临床有用信息。确定与危急血清化学指标值（CSCVs）相关的临床标准。
回顾性分析一家城市一级创伤中心在1989年7月1日至12月31日期间收治的所有创伤患者的病历。研究所有在入院时及出院前至少再次进行过一次血清化学测定的创伤患者。在病历审查之前，由一组专家确定CSCVs。对血清化学指标值、患者人口统计学资料、损伤机制和预后进行统计学分析。
大多数（814/913；89%）创伤患者血清化学指标值异常。然而，只有54/913（6%）患者有CSCVs，其中只有6个CSCVs促使了复苏或治疗的改变（静脉输注钾治疗）。年龄>50岁、有高血压治疗史以及格拉斯哥昏迷量表评分≤10分与CSCVs相关；CSCVs与死亡率增加和入住重症监护病房相关。
对于主要创伤患者，常规入院时的血清化学指标值虽常异常，但在创伤患者的复苏和治疗中一般不提供临床有用信息。使用床边血糖测定和动脉血气评估能更快地确定低血糖和代谢性酸中毒。该研究中描述的常规入院血清化学指标检查对大多数创伤患者无用。对于主要创伤患者，入院时应采用选择性化学指标检查。
