Stratton S J, Brickett K, Crammer T
Harbor-UCLA Medical Center, Los Angeles, California, USA.
J Trauma. 1998 Jul;45(1):96-100. doi: 10.1097/00005373-199807000-00021.
This study was designed to determine whether out-of-hospital clinical signs could be associated with functional survival for pulseless, unconscious victims of penetrating trauma.
A retrospective review of medical data and outcome for pulseless, unconscious penetrating urban trauma victims during 1993-1994. For comparison with the penetrating study group, data for blunt pulseless, unconscious trauma victims for the same period are reported. Logistic regression, odds ratios, positive predictive values, sensitivity, and specificity were used to determine the possible association of field clinical signs with survival.
A total of 879 penetrating and blunt trauma victims met criteria of the study. Four of 497 victims of penetrating injury survived. Three of the four survivors were neurologically intact, with the remaining survivor impaired but functional in a supervised work setting. All survivors of penetrating trauma had monitored cardiac electrical (sinus rhythm or sinus tachycardia) activity on presentation in the field, and three were stabbing victims. Age, total field treatment time, spontaneous respiration, reactive pupils, and return of pulse in the field were not found to be associated with survival. Four victims of penetrating injury survived long enough to donate perfused asystolic-sensitive (kidney, liver, lung, and pancreas) organs. There were 382 victims of blunt injury that met study inclusion criteria with five survivors. None of the five survivors of blunt injury had good neurologic function.
Functional survival was rare but did occur with penetrating trauma presenting pulseless and unconscious in the out-of-hospital setting. Although the presence of a pulseless sinus rhythm or tachycardia and stabbing as a mechanism seemed to indicate better survival rates, our study failed to identify reliable out-of-hospital criteria to separate salvageable penetrating trauma victims from those who are nonsalvageable. With this lack of reliable criteria, aggressive prehospital resuscitation efforts and rapid transport to the nearest trauma center for pulseless, unconscious victims of penetrating injury seem indicated.
本研究旨在确定院外临床体征是否与穿透性创伤导致的无脉、无意识受害者的功能存活相关。
对1993年至1994年间城市中无脉、无意识的穿透性创伤受害者的医疗数据及结果进行回顾性分析。为了与穿透性研究组进行比较，报告了同期钝性无脉、无意识创伤受害者的数据。采用逻辑回归、比值比、阳性预测值、敏感性和特异性来确定现场临床体征与存活之间的可能关联。
共有879名穿透性和钝性创伤受害者符合研究标准。497名穿透伤受害者中有4人存活。4名幸存者中有3人神经功能完好，其余1名幸存者有损伤但在有监督的工作环境中仍有功能。所有穿透伤幸存者在现场就诊时均监测到心脏电活动（窦性心律或窦性心动过速），其中3人是刺伤受害者。未发现年龄、现场总治疗时间、自主呼吸、瞳孔反应及现场脉搏恢复与存活相关。4名穿透伤受害者存活时间足够长，能够捐献灌注无收缩反应敏感（肾、肝、肺和胰腺）器官。有382名钝性伤受害者符合研究纳入标准，其中5人存活。钝性伤幸存者中无一例神经功能良好。
功能存活虽罕见，但在院外环境中确实发生于无脉、无意识的穿透性创伤患者。尽管无脉性窦性心律或心动过速的存在以及刺伤作为一种机制似乎表明存活率较高，但我们的研究未能确定可靠的院外标准来区分可挽救的穿透性创伤受害者和不可挽救的受害者。由于缺乏可靠标准，对于无脉、无意识的穿透伤受害者，似乎应在院前进行积极的复苏努力并迅速转运至最近的创伤中心。
