Hypotension, hypoxia, and head injury - Frequency, duration, and consequences
Hypotension, hypoxia, and head injury - Frequency, duration, and consequences
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DOI：
10.1001/archsurg.136.10.1118
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发表时间：
2001-10-01
影响因子：
--
通讯作者：
Pitts, L
中科院分区：
文献类型：
--
作者：
Manley, G;Knudson, MM;Pitts, L
背景资料：回顾性研究表明，全身性低血压和缺氧与创伤性脑损伤预后恶化之间存在相关性。然而，人们对这些潜在可预防的继发性脑损伤原因的频率和持续时间知之甚少。假设：初始复苏期间发生的早期缺氧和低血压将对创伤性脑损伤后的结果产生显着影响。设计：前瞻性队列研究。设置：城市一级创伤中心。患者：在入院前24小时内格拉斯哥昏迷评分为12或更低且计算机断层扫描结果显示颅内病理特征的创伤性脑损伤患者。在急诊室死亡的患者被排除在study.Main结果测量：自动血压和脉搏血氧饱和度读数收集前瞻性的到达时间，通过初始复苏。水肿（收缩压，小于或等于90毫米汞柱）和缺氧（氧饱和度，小于或等于92%）事件的数量和持续时间进行了分析，其与死亡率和神经系统outcome.Results：107例患者符合入组标准（中位数格拉斯哥昏迷评分，7）。总死亡率为43%。26例患者（24%）在急诊室时发生低血压，平均每例患者1.5次发作（平均持续时间9.1分钟）。在这26例低血压患者中，17例（65%）死亡（P= 0.01）。当癫痫发作次数从1次增加到2次或更多时，死亡的比值比从2增加。1到8。1. 41例患者（38%）出现缺氧，平均每例患者2.1次（平均持续时间8.7分钟）。在这41例缺氧患者中，18例（44%）死亡（P= 0.68）。结论：在复苏的初始阶段发生的低血压（而不是缺氧）与脑损伤后死亡率的增加显著相关（P= 0.009），即使发作时间相对较短。这些前瞻性数据强调了对脑损伤患者低血压进行早期连续监测和改善治疗的必要性。
Background: Retrospective studies have suggested an association between systemic hypotension and hypoxia and worsened outcome from traumatic brain injury. Little is known, however, about the frequency and duration of these potentially preventable causes of secondary brain injury.Hypothesis: Early episodes of hypoxia and hypotension occurring during initial resuscitation will have a significant impact on outcome following traumatic brain injury.Design: Prospective cohort study.Setting: Urban level I trauma center.Patients: Patients with a traumatic brain injury who had a Glasgow Coma Score of 12 or less within the first 24 hours of admission to the hospital and computed tomographic scan results demonstrating intracranial pathologic features. Patients who died in the emergency department were excluded from the study.Main Outcome Measures: Automated blood pressure and pulse oximetry readings were collected prospectively from the time of arrival through initial resuscitation. The number and duration of hypotensive (systolic blood pressure, less than or equal to 90 mm Hg) and hypoxic (oxygen saturation, less than or equal to 92%) events were analyzed for their association with mortality and neurological outcome.Results: One hundred seven patients met the enrollment criteria (median Glasgow Coma Score, 7). Overall mortality was 43%. Twenty-six patients (24%) had hypotension while in the emergency department, with an average of 1.5 episodes per patient (mean duration, 9.1 minutes). Of these 26 patients with hypotension, 17 (65%) died (P=.01). When the number of hypotensive episodes increased from I to 2 or more, the odds ratio for death increased from 2. 1 to 8. 1. Forty-one patients (38%) had hypoxia, with an average of 2.1 episodes per patient (mean duration, 8.7 minutes). Of these 41 patients with hypoxia, 18 (44%) died (P=.68).Conclusions: Hypotension, but not hypoxia, occurring in the initial phase of resuscitation is significantly (P=.009) associated with increased mortality following brain injury, even when episodes are relatively short. These prospective data reinforce the need for early continuous monitoring and improved treatment of hypotension in brain-injured patients.