Boulanger B R, Milzman D P, Rosati C, Rodriguez A
Department of Traumatology, R Adams Cowley Shock Trauma Center, Maryland Institute for Emergency Medical Services Systems, Baltimore.
Can J Surg. 1993 Feb;36(1):63-9.
The clinical value of total serum amylase (TSA) levels measured after blunt trauma remains controversial. To test the utility of this measurement, the authors surveyed the routine admission TSA levels of 4316 adults who were victims of blunt trauma. Most patients (58.2%) had been injured in motor vehicle accidents, and all were admitted directly from the accident scene. Patients were divided into two groups based on the admission TSA level: more than 125 U/L (abnormal) and 125 U/L or less (normal). Of the 4316 patients, 3920 (90.8%) had a normal TSA level upon admission. Hyperamylasemia was associated with a greater injury severity score (ISS) and death rate, a lower admission Glasgow Coma Scale score and an increased incidence of facial fracture, brain injury, pancreatic and hollow-viscus injuries and hypotension (p < 0.01). However, the positive predictive value of an abnormal TSA level for pancreatic and hollow-viscus injuries was 1.5% and 3.0% respectively. Also, most patients with pancreatic (65%) and hollow-viscus (83%) injuries had a normal TSA level. There was no relation between the anatomic grade of pancreatic injury and the TSA level. Acute hyperamylasemia after blunt trauma appears to be a poor predictor of pancreatic and hollow-viscus injuries. Therefore, urgent TSA determinations should not influence the clinical and radiologic evaluation of the blunt trauma victim.
钝性创伤后测定的血清总淀粉酶（TSA）水平的临床价值仍存在争议。为了检验这一测量方法的效用，作者调查了4316名钝性创伤成年受害者的常规入院TSA水平。大多数患者（58.2%）在机动车事故中受伤，且均直接从事故现场入院。根据入院时的TSA水平将患者分为两组：超过125 U/L（异常）和125 U/L及以下（正常）。在4316例患者中，3920例（90.8%）入院时TSA水平正常。高淀粉酶血症与更高的损伤严重度评分（ISS）和死亡率、更低的入院格拉斯哥昏迷量表评分以及面部骨折、脑损伤、胰腺和中空脏器损伤及低血压的发生率增加相关（p<0.01）。然而，TSA水平异常对胰腺和中空脏器损伤的阳性预测值分别为1.5%和3.0%。此外，大多数胰腺损伤（65%）和中空脏器损伤（83%）的患者TSA水平正常。胰腺损伤的解剖学分级与TSA水平之间无关联。钝性创伤后的急性高淀粉酶血症似乎是胰腺和中空脏器损伤的不良预测指标。因此，紧急测定TSA不应影响钝性创伤受害者的临床和影像学评估。
