院前血气分析:一项队列研究:由地面医生值守的急救单位对急性病患者进行的治疗

Louise Houlberg Walther, Annmarie Touborg Lassen, Christian Backer Mogensen, Erika Frischknecht Christensen, Søren Mikkelsen
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引用次数: 0

摘要

接受救护车和移动急救单元(MECU)治疗的院前病人可能病情危重或受伤严重。了解这些患者出现严重后果的风险对于指导治疗非常重要。有些情况下可以进行院前动脉血气分析。本研究旨在评估院前患者的预后与其院前测量的乳酸、pH 值和二氧化碳水平的关系。主要结果是 7 天死亡率。这项以登记为基础的队列研究纳入了 2015 年 1 月至 2018 年 12 月由医生值守的 MECU 在院前治疗期间进行过一次或多次院前血气分析的患者。血液样本由 ABL90 Flex 分析仪进行分析。计算了预设亚组中主要和次要结果的绝对值(含百分比)和几率比(OR)(含 95% 置信区间 (CI))。研究共纳入 745 名患者,7 天总死亡率为 20.0%。与 pH 值正常(7.35-7.45)的参照组相比,乳酸水平正常(7.45)的患者 7 天死亡率为 11.5%。与二氧化碳含量正常的参照组(4.3-6.0 千帕)相比,血液二氧化碳含量为 6.0 千帕的患者 7 天死亡率的 ORs 为 2.54(95% CI:1.45-4.46)。该研究发现,在接受院前血液分析的院前患者中,7 天死亡率的增加与血液乳酸水平高、pH 值低和血液二氧化碳水平异常之间存在密切联系。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Prehospital blood gas analyses in acute patients treated by a ground-based physician-manned emergency unit: a cohort study
The prehospital patients treated by ambulances and mobile emergency care units (MECU) are potentially critically ill or injured. Knowing the risks of serious outcomes in these patients is important for guiding their treatment. Some settings allow for prehospital arterial blood gas analyses. This study aimed to assess the outcomes of prehospital patients in relation to their prehospitally measured lactate, pH, and CO2 levels. The primary outcome was 7-day mortality. This register-based cohort study included patients with one or more prehospital blood gas analyses during their prehospital treatment by a physician-manned MECU, from January 2015 to December 2018. The blood samples were analyzed on an ABL90 Flex analyzer. Absolute values with percentages and odds ratios (OR) with 95% confidence intervals (CI) were calculated for the primary and secondary outcomes within prespecified subgroups. The study included 745 patients, with an overall 7-day mortality rate of 20.0%. The 7-day mortality rates were 11.5% in patients with normal lactate levels (< 2.0 mmol/L), 14.4% with intermediate lactate levels (2.0–3.9 mmol/L), and 33.0% with high lactate levels (≥ 4.0 mmol/L). This corresponded to an OR of 1.30 (95% CI: 0.75–2.24) in the intermediate lactate group (2.0–3.9 mmol/L) and an OR of 3.77 (95% CI: 2.44–5.85) in the high lactate group (≥ 4.0 mmol/L), compared to the reference group with normal lactate. The ORs of 7-day mortality rates were 4.82 (95% CI: 3.00–7.75) in patients with blood pH of < 7.35 and 1.33 (95% CI: 0.65–2.72) in patients with blood pH > 7.45, compared to the reference group with normal pH (7.35–7.45). The ORs of 7-day mortality rates were 2.54 (95% CI: 1.45–4.46) in patients with blood CO2 of < 4.3 kPa and 2.62 (95% CI: 1.70–4.03) in patients with blood CO2 > 6.0 kPa, compared to the reference group with normal CO2 (4.3–6.0 kPa). This study found a strong correlation between increasing 7-day mortality rates and high blood lactate levels, low levels of pH, and abnormal CO2 blood levels, in prehospital patients undergoing prehospital blood analysis.
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