Davis J W, Kaups K L, Parks S N
Department of Surgery, University of South Florida, Tampa, USA.
J Trauma. 1998 Jan;44(1):114-8. doi: 10.1097/00005373-199801000-00014.
This study was done to evaluate the differences in base deficit (BD) clearance, pH normalization, and the occurrence of complications between survivors and nonsurvivors after trauma.
Concurrent data entry with retrospective review.
Trauma patients meeting registry criteria from July 1990 through August 1995 with arterial blood gases performed within 1 hour of admission and admission BD < or = -6 were included. Data was grouped by BD category (moderate, -6 to -9; severe, < or = -10). Group means +/- SEM were compared with a two-tailed t test.
Six hundred seventy-four patients met entry criteria. Survivors in both the moderate and severe BD groups had improved their BD within 4 hours and normalized their BD by 16 hours. Nonsurvivors did not improve their BD category until 8 hours (for the severe group) and 16 hours (for the moderate group) and did not normalize BD before 24 hours. The BD differences between survivors and nonsurvivors were significant at each time interval, whereas pH differences were significant at 2 hours in the moderate group and at 2, 16, and 24 hours in the severe group. Patients who failed to improve their BD > -6 had an increased frequency of adult respiratory distress syndrome, multiple organ failure, and mortality.
Base deficit reveals differences in metabolic acidosis between survivors and nonsurvivors not shown by pH determinations and is clearly a better marker of acidosis clearance after shock.
本研究旨在评估创伤后幸存者与非幸存者在碱缺失（BD）清除、pH值恢复正常以及并发症发生情况方面的差异。
同步数据录入与回顾性分析。
纳入1990年7月至1995年8月符合登记标准、入院1小时内进行动脉血气分析且入院时BD≤ -6的创伤患者。数据按BD类别分组（中度，-6至-9；重度，≤ -10）。采用双侧t检验比较组均值±标准误。
674例患者符合入选标准。中度和重度BD组的幸存者在4小时内BD有所改善，16小时内BD恢复正常。非幸存者直到8小时（重度组）和16小时（中度组）BD类别才有所改善，24小时前BD未恢复正常。幸存者与非幸存者在每个时间间隔的BD差异均有统计学意义，而pH差异在中度组2小时以及重度组2、16和24小时有统计学意义。BD未能改善至＞ -6的患者发生成人呼吸窘迫综合征、多器官功能衰竭及死亡的频率增加。
碱缺失揭示了幸存者与非幸存者在代谢性酸中毒方面pH测定未显示出的差异，显然是休克后酸中毒清除的更好指标。
