Clinical indicators of hemorrhagic shock in pregnancy.
Clinical indicators of hemorrhagic shock in pregnancy.
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DOI：
10.1136/tsaco-2017-000112
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发表时间：
2017
影响因子：
2
通讯作者：
Zarzaur BL
中科院分区：
文献类型：
--
作者：
Jenkins PC;Stokes SM;Fakoyeho S;Bell TM;Zarzaur BL
一些血流动力学参数已经被推广，以帮助建立失血性休克的快速诊断，但它们在怀孕人群中尚未得到很好的验证。在这项研究中，我们研究了三种休克指标与妊娠创伤患者早期输血需求之间的关系。这项研究包括在一级创伤中心住院的81名妊娠创伤患者(2010-2015)。在单独的Logistic回归模型中，我们测试了暴露变量-初始收缩压、休克指数和超压评估率(ROPE)-与入院24 小时内输血产品的结果之间的关系。为了测试每个测量的预测能力，我们使用了接收器工作特性(ROC)曲线。在患者队列中，总共有10%的患者接受了血液产品。没有患者的初始收缩压≤90，因此收缩压测量被排除在分析之外。我们发现，与SI<；1患者相比，SI>；1患者接受输血的可能性显著更高(OR10.35；95%可信区间1.80至59.62)，而与ROPE>；3患者相比，ROPE>；3患者与输血无关(OR 2.92；95%CI 0.28至30.42)。此外，SI(0.68)和ROPE(0.54)ROC曲线下面积的比较表明，SI比输血ROC曲线下面积更具预测性。我们发现，在受伤的妊娠患者中，SI升高与早期输血的关系比SBP和ROPE更密切。预测，III级
Several hemodynamic parameters have been promoted to help establish a rapid diagnosis of hemorrhagic shock, but they have not been well validated in the pregnant population. In this study, we examined the association between three measures of shock and early blood transfusion requirements among pregnant trauma patients. This study included 81 pregnant trauma patients admitted to a level 1 trauma center (2010–2015). In separate logistic regression models, we tested the relationship between exposure variables—initial systolic blood pressure (SBP), shock index (SI), and rate over pressure evaluation (ROPE)—and the outcome of transfusion of blood products within 24 hours of admission. To test the predictive ability of each measure, we used receiver operating characteristic (ROC) curves. A total of 10% of patients received blood products in the patient cohort. No patients had an initial SBP≤90, so the SBP measure was excluded from analysis. We found that patients with SI>1 were significantly more likely to receive blood transfusions compared with patients with SI<1 (OR 10.35; 95% CI 1.80 to 59.62), whereas ROPE>3 was not associated with blood transfusion compared with ROPE≤3 (OR 2.92; 95% CI 0.28 to 30.42). Furthermore, comparison of area under the ROC curve for SI (0.68) and ROPE (0.54) suggested that SI was more predictive than ROPE of blood transfusion. We found that an elevated SI was more closely associated with early blood product transfusion than SBP and ROPE in injured pregnant patients. Prognostic, level III