Early hypotension worsens neurological outcome in pediatric patients with moderately severe head trauma
Early hypotension worsens neurological outcome in pediatric patients with moderately severe head trauma
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DOI：
10.1016/s0022-3468(98)90457-2
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发表时间：
1998-02-01
影响因子：
2.4
通讯作者：
Weber, TR
中科院分区：
文献类型：
--
作者：
Kokoska, ER;Smith, GS;Weber, TR
目的：本研究的目的是确定儿童颅脑创伤恢复期低血压的发生率。方法：对1990年至1995年在一家一级儿科创伤机构进行的回顾性研究。纳入标准包括格拉斯哥昏迷评分(GCS)6到8，以及没有穿透性创伤或出血障碍。GCS由神经外科医生通过复苏后检查进行分配。低血压被定义为持续时间超过5分钟的血压读数低于年龄的5个百分位数。从受伤开始到住院的前24小时都对事件进行了监测。格拉斯哥预后评分(GOS)基于3个月的随访评估。对所有病例进行方差分析和列联表分析，P值小于.05表示有统计学意义。结果：72例患者符合纳入标准。他们的平均GCS为7.2，平均年龄为6岁；97%的患者存活。早期低血压与较差的神经预后(GOS)和较长的住院时间相关。GOS与年龄、性别、损伤机制、合并损伤或运输时间无显著相关性。结论：这些数据表明，在儿童闭合性脑外伤患者的早期复苏过程中，保持足够的血压可能会改善神经预后。版权所有(C)1998年，W.B.桑德斯公司。
Purpose: The objective of this study was to determine the morbidity associated with hypotension in the resuscitative phase of pediatric head trauma.Methods: A retrospective review (1990 to 1995) was performed at a level-1 pediatric trauma facility. Inclusion criteria included a Glasgow coma score (GCS) of 6 to 8 and absence of penetrating trauma or bleeding disorders. The GCS was assigned using a postresuscitation examination by a neurosurgeon. Hypotension was defined as a blood pressure reading of less than the fifth percentile for age that lasted longer than 5 minutes. Episodes were monitored from the onset of injury through the first 24 hours of hospitalization. Glasgow outcome scale (GOS) was assigned based on a 3-month follow-up evaluation. Analysis of variance (ANOVA) and contingency table analysis were performed on all groups, and a P value of less than .05 was taken to represent statistical significance.Results: Seventy-two patients met inclusion criteria. They had a mean GCS of 7.2 and a mean age of 6 years; 97% survived. Early hypotension was associated with worse neurological outcome (GOS) and prolonged hospitalization. There was no significant correlation between GOS and age, gender, injury mechanism, associated injuries, or transport time.Conclusions: These data suggest that maintaining adequate blood pressure during the early resuscitation of pediatric blunt head trauma patients may improve neurological outcome. Copyright (C) 1998 by W.B. Saunders Company.