Cayten C G, Murphy J G, Stahl W M
Institute for Trauma and Emergency Care, New York Medical College, Valhalla.
J Trauma. 1993 Sep;35(3):460-6; discussion 466-7. doi: 10.1097/00005373-199309000-00021.
To study the value of advanced life support (ALS) compared with basic life support (BLS) for penetrating and motor vehicle crash (MVC) patients, data were collected from eight hospitals over 24 months on 781 consecutive patients with Injury Severity Scores > or = 10 as well as on a subset of 219 hypotensive patients. Initial prehospital Revised Trauma Scores (RTSs) were compared with initial emergency department RTSs. Scene times, total prehospital times, and the use of a pneumatic antishock garment (PASG), intravenous fluids, and endotracheal intubation were also documented. A modified TRISS method was used to compare mortality rates. The MVC ALS patients showed improvement in mean RTSs between prehospital and the emergency department while MVC BLS patients did not. Mean changes in blood pressure (BP) and the percentage of patients with improved BP were significantly higher among patients who received ALS; ALS was associated with increased use of PASGs and IV fluids. There were no differences between groups with respect to observed versus predicted mortality. Similar results were found in the hypotensive subset of patients. No benefit from the use of ALS for trauma patients with total prehospital times of less than 35 minutes was documented.
为研究高级生命支持（ALS）与基础生命支持（BLS）相比对穿透伤和机动车碰撞（MVC）患者的价值，在24个月内从8家医院收集了781例连续的损伤严重度评分≥10分患者以及219例低血压患者亚组的数据。将院前初始修订创伤评分（RTS）与急诊科初始RTS进行比较。还记录了现场时间、总院前时间以及气动抗休克衣（PASG）、静脉输液和气管插管的使用情况。采用改良的TRISS方法比较死亡率。MVC的ALS患者在院前和急诊科之间的平均RTS有所改善，而MVC的BLS患者则没有。接受ALS的患者血压（BP）的平均变化以及血压改善患者的百分比显著更高；ALS与PASG和静脉输液的使用增加有关。观察到的死亡率与预测死亡率在组间没有差异。在低血压患者亚组中也发现了类似结果。未记录到院前总时间少于35分钟的创伤患者使用ALS有任何益处。
