压力预防后创伤性脑损伤患者的结果:一项回顾性多中心研究
Constance McGraw1, Abigale Briscoe2, Cassandra Reynolds3
1Trauma Research, Swedish Medical Center, Englewood, Colorado, USA.
Trauma surgery & acute care open
|February 27, 2024
概括
压力预防 (SUP) 在神经临床护理中很常见,但可能不会减少出血. SUP可能有利于严重创伤性脑损伤 (TBI) 和脊髓损伤 (SCI) 患者,但会增加肺炎的风险.
科学领域:
- 神经临界护理是指神经临界护理.
- 创伤外科 手术 创伤外科
- 胃肠病学 胃肠病学
背景情况:
- 压力在创伤性脑损伤 (TBI) 和脊髓损伤 (SCI) 患者中存在风险.
- 压力预防 (SUP) 经常用于神经临床护理,尽管报告的压力率很低.
- 普遍SUP在减少神经临床护理中的并发症的有效性受到质疑.
研究的目的:
- 评估压力预防 (SUP) 和神经临床关键护理患者临床显著的胃肠道出血 (CSGIBs) 之间的关联.
- 评估SUP对二次结局的影响,包括肺炎和住院死亡率.
- 通过格拉斯哥昏迷尺度 (GCS) 评分分层的不同严重程度的神经障碍探索这些关联.
主要方法:
- 在六个I级创伤中心对407名中度至重度TBI或SCI的成年神经临床护理患者进行了回顾性研究.
- 患者根据入院格拉斯哥昏迷表 (GCS) 评分进行了分层.
- 主要结局是临床显著的胃肠道出血 (CSGIBs);次要结局包括肺炎和住院死亡率.
主要成果:
- 总体而言,CSGIBs很罕见 (1%),并且在SUP和非SUP组之间没有显著差异 (p=0.06).
- CSGIBs仅发生在GCS得分为3-8的患者中,SUP在这个小组中显著减少 (p=0.03).
- 在GCS 3-8和GCS 9-12患者中,SUP与肺炎的发生率显著增加有关.
结论:
- 在神经临界创伤患者中,临床显著的胃肠道出血不常见.
- 压力的预防可能为CSGIB减轻严重神经功能障碍 (GCS 3-8) 的患者提供好处.
- 与SUP相关的肺炎风险增加需要谨慎应用,并进一步研究最佳指导方针.
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