格拉斯哥昏迷尺度输管门和创伤性脑损伤患者的结果:需要量身定制的实践管理准则
Adel Elkbuli1,2, Tessa Breeding3, Micah Ngatuvai3
1Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, FL, USA.
The American surgeon
|July 29, 2023
概括
对于创伤性脑损伤 (TBI) 患者,只有当格拉斯哥昏迷量表 (GCS) 为5或以下时,输管治疗才是有益的. 更高的GCS值用于输管增加死亡率和并发症.
科学领域:
- 紧急医疗 紧急医疗
- 神经外科 神经外科
- 创伤外科 手术 创伤外科
背景情况:
- 创伤性脑损伤 (TBI) 管理需要仔细考虑呼吸道干预措施.
- 目前对TBI患者输管治疗的实践指南是基于格拉斯哥昏迷量表 (GCS).
- 重新评估用于输管的最佳GCS值对于改善患者的治疗结果至关重要.
研究的目的:
- 重新评估格拉斯哥昏迷量表 (GCS) 临界值用于急诊室 (ED) 创伤性脑损伤 (TBI) 患者的输入管.
- 为了优化患者的结果,并为未来的实践管理准则提供证据.
- 确定GCS输管门和患者结果之间的关联.
主要方法:
- 从2015-2019年对ACS-TQIP-参与者使用文件 (PUF) 的回顾性审查.
- 包括成年创伤患者 (≥18岁) 带有头伤害和CT扫描.
- 多变量回归分析以评估GCS值为5,8和10的结果.
主要成果:
- 在输入管和未输入管的患者之间,对于GCS ≤5的死亡率,并发症或ICU停留时间 (LOS) 没有显著差异.
- 在GCS值≤8和≤10的输入管与与未输入管患者相比显著更高的死亡率有关.
- 在GCS值>5的输入管导致并发症增加和更长的ICU-LOS.
结论:
- GCS ≤5是TBI患者输管治疗可能在没有恶化结果的情况下提供好处的门.
- 创伤协会和机构应该重新考虑现有的TBI输管门指南.
- 优化GCS输管门可以导致更安全的程序和更好的患者结果.
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