Bickell W H, Wall M J, Pepe P E, Martin R R, Ginger V F, Allen M K, Mattox K L
Department of Emergency Services, Saint Francis Hospital, Tulsa, Okla.
N Engl J Med. 1994 Oct 27;331(17):1105-9. doi: 10.1056/NEJM199410273311701.
Fluid resuscitation may be detrimental when given before bleeding is controlled in patients with trauma. The purpose of this study was to determine the effects of delaying fluid resuscitation until the time of operative intervention in hypotensive patients with penetrating injuries to the torso.
We conducted a prospective trial comparing immediate and delayed fluid resuscitation in 598 adults with penetrating torso injuries who presented with a pre-hospital systolic blood pressure of < or = 90 mm Hg. The study setting was a city with a single centralized system of pre-hospital emergency care and a single receiving facility for patients with major trauma. Patients assigned to the immediate-resuscitation group received standard fluid resuscitation before they reached the hospital and in the trauma center, and those assigned to the delayed-resuscitation group received intravenous cannulation but no fluid resuscitation until they reached the operating room.
Among the 289 patients who received delayed fluid resuscitation, 203 (70 percent) survived and were discharged from the hospital, as compared with 193 of the 309 patients (62 percent) who received immediate fluid resuscitation (P = 0.04). The mean estimated intraoperative blood loss was similar in the two groups. Among the 238 patients in the delayed-resuscitation group who survived to the postoperative period, 55 (23 percent) had one or more complications (adult respiratory distress syndrome, sepsis syndrome, acute renal failure, coagulopathy, wound infection, and pneumonia), as compared with 69 of the 227 patients (30 percent) in the immediate-resuscitation group (P = 0.08). The duration of hospitalization was shorter in the delayed-resuscitation group.
For hypotensive patients with penetrating torso injuries, delay of aggressive fluid resuscitation until operative intervention improves the outcome.
对于创伤患者，在出血得到控制之前进行液体复苏可能有害。本研究的目的是确定对于低血压的穿透性躯干损伤患者，将液体复苏延迟至手术干预时的效果。
我们进行了一项前瞻性试验，比较了598例院前收缩压≤90mmHg的穿透性躯干损伤成年患者立即进行液体复苏和延迟进行液体复苏的效果。研究地点是一个拥有单一集中院前急救系统和单一重大创伤患者接收机构的城市。分配到立即复苏组的患者在到达医院和创伤中心之前接受标准液体复苏，而分配到延迟复苏组的患者接受静脉置管，但在到达手术室之前不进行液体复苏。
在289例接受延迟液体复苏的患者中，203例（70%）存活并出院，而在309例接受立即液体复苏的患者中，有193例（62%）存活出院（P = 0.04）。两组的平均估计术中失血量相似。在延迟复苏组中存活至术后的238例患者中，55例（23%）发生了一种或多种并发症（成人呼吸窘迫综合征、脓毒症综合征、急性肾衰竭、凝血病、伤口感染和肺炎），而立即复苏组的227例患者中有69例（30%）发生并发症（P = 0.08）。延迟复苏组的住院时间较短。
对于低血压的穿透性躯干损伤患者，将积极的液体复苏延迟至手术干预可改善预后。
