在第三级创伤中心创伤性大出血的特征
Pieter van Wyk1, Marcus Wannberg2, Anna Gustafsson3
1Section of Acute and Trauma Surgery, Karolinska University Hospital, Stockholm, Sweden.
概括
严重创伤性出血,定义为在2小时内输入4个单位血液,影响2.1%的创伤患者. 年轻的男性有穿透性创伤和低血压的风险更高,需要快速控制出血.
科学领域:
- 创伤外科 手术 创伤外科
- 血液性冲击管理 血液性冲击管理
- 复苏医学 复苏医学 复苏医学
背景情况:
- 严重创伤性出血仍然是死亡的重要原因,尽管在医院前护理的进步.
- 有效的出血控制和复苏对于改善创伤患者的治疗结果至关重要.
- 基于输血的定义有助于识别患有重大出血风险的患者.
研究的目的:
- 用基于输血的定义来描述患有重大出血风险的患者.
- 为了确定与创伤后严重出血相关的危险因素.
- 为了分析主要出血创伤队列中的结果.
主要方法:
- 对7020名创伤患者 (2015-2020年) 的回顾性队列研究.
- 严重出血定义为在受伤后2小时内输血≥4个血液成分.
- 后勤回归分析确定了24小时和30天死亡率的风险因素.
主要成果:
- 主要出血队列 (2.1%) 包含年轻男性,受伤严重程度得分 (ISS) 高,创伤更深入.
- 风险因素包括医院前/ED低血压,低基数过量,高INR,以及紧急损伤控制腹腔切除术.
- 24小时死亡率为6.9%,与医院前心脏骤停和运输时间相关.
结论:
- 大型出血创伤患者更年轻,男性,具有更高的ISS,以及更透的伤害.
- 早期识别高危患者对于及时控制出血至关重要.
- 医院前的心脏骤停和运输时间是24小时死亡率的关键预测指标.
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