Gomez G A, Jacobson L E, Asensio J A, Nauta R J
Department of Surgery, Indiana University School of Medicine, Indianapolis.
Crit Care Clin. 1994 Jul;10(3):555-66.
Interest in the importance of pre-existing disease as an outcome predictor in trauma patients has begun to receive attention only recently. Data relating specifically to pre-existing liver disease remains scant. With an overall prevalence of 0.5% among all trauma patients, pre-existing liver disease has been shown to increase mean duration of hospital stay by up to 36% and mortality by a factor of five (Table 9). This data appears to support the recommendation of the American College of Surgeons Committee on Trauma in their most recent bulletin, "Resources for the Optimal Care of the Injured Patient," that a history of cirrhosis in an injured patient should alert prehospital providers to contact medical control and consider transport to a trauma center. The majority of the data on the pathophysiologic and clinical responses and management of the patient with pre-existing liver disease have been extrapolated from literature on liver disease in the surgical patient and in sepsis. Few specific data on the management of the trauma patient with pre-existing liver disease and its effects on morbidity and mortality are available. We hope this review stimulates further research, particularly on the pathophysiologic and clinical responses to trauma exhibited by patients with liver disease.
对创伤患者中既往疾病作为预后预测指标的重要性的关注直到最近才开始受到重视。专门针对既往肝病的数据仍然很少。在所有创伤患者中，既往肝病的总体患病率为0.5%，已显示其会使平均住院时间延长多达36%，死亡率增加五倍（表9）。这些数据似乎支持美国外科医师学会创伤委员会在其最新公告《受伤患者最佳护理资源》中的建议，即受伤患者有肝硬化病史应提醒院前急救人员联系医疗指挥并考虑转运至创伤中心。关于既往肝病患者的病理生理和临床反应及管理的大多数数据是从外科患者和脓毒症患者的肝病文献中推断出来的。关于既往肝病创伤患者的管理及其对发病率和死亡率影响的具体数据很少。我们希望这篇综述能激发进一步的研究，特别是关于肝病患者对创伤的病理生理和临床反应的研究。
