院前急救麻醉后创伤患者的临界高血压:一项多中心回顾性观察研究

Liam Sagi, James Price, Kate Lachowycz, Zachary Starr, Rob Major, Chris Keeliher, Benjamin Finbow, Sarah McLachlan, Lyle Moncur, Alistair Steel, Peter B. Sherren, Ed B G Barnard
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引用次数: 0

摘要

重大创伤患者的危重高血压与死亡率增加有关。10%的重伤患者需要进行院前急救麻醉(PHEA)。优化氧合、通气和脑灌注,同时避免血流动力学剧烈波动是减少继发性脑损伤的基石。本研究旨在报告三个直升机紧急医疗服务(HEMS)机构的大型区域性创伤患者数据集中 PHEA 后危重高血压的不同决定因素。这是一项多中心回顾性观察研究,研究对象是在英国三家直升机紧急医疗服务机构接受 PHEA 的连续成年创伤患者(2015-2022 年)。重度高血压的定义是在麻醉诱导后 10 分钟内新出现的收缩压 (SBP) > 180mmHg,或如果诱导前的基线 SBP > 180mmHg,则升高 > 10%。在多变量模型中,采用有目的的逻辑回归来探讨与 PHEA 后临界高血压相关的变量。数据以人数(百分比)、几率比(OR)和 95% 置信区间(95%CI)表示。研究期间,30744 名患者接受了急诊急救服务;2161 名患者接受了 PHEA,1355 名患者被纳入最终分析。161名患者(11.9%)在PHEA后10分钟内出现一次或多次新的临界高血压。年龄增加(与 16-34 岁相比):35-54岁(OR 1.76,95%CI 1.03-3.06);55-74岁(OR 2.00,95%CI 1.19-3.44);≥75岁(OR 2.38,95%CI 1.31-4.35),PHEA前格拉斯哥昏迷量表(GCS)运动评分四级(OR 2.17,95%CI 1.19-4.01)和五级(OR 2.82,95%CI 1.60-7.09)、PHEA 前 SBP > 140mmHg 的患者(OR 6.72,95%CI 4.38-10.54)和不止一次插管尝试(OR 1.75,95%CI 1.01-2.96)与 PHEA 后危重高血压有关。为重伤创伤患者提供 PHEA 有可能导致血流动力学波动。在接受PHEA治疗的成年创伤患者中,11.9%的患者出现了PHEA后危重高血压。年龄增大、PHEA前GCS运动评分为4分和5分、PHEA前SBP>140mmHg以及多次尝试插管与PHEA后危重高血压独立相关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Critical hypertension in trauma patients following prehospital emergency anaesthesia: a multi-centre retrospective observational study
Critical hypertension in major trauma patients is associated with increased mortality. Prehospital emergency anaesthesia (PHEA) is performed for 10% of the most seriously injured patients. Optimising oxygenation, ventilation, and cerebral perfusion, whilst avoiding extreme haemodynamic fluctuations are the cornerstones of reducing secondary brain injury. The aim of this study was to report the differential determinants of post-PHEA critical hypertension in a large regional dataset of trauma patients across three Helicopter Emergency Medical Service (HEMS) organisations. A multi-centre retrospective observational study of consecutive adult trauma patients undergoing PHEA across three HEMS in the United Kingdom; 2015–2022. Critical hypertension was defined as a new systolic blood pressure (SBP) > 180mmHg within 10 min of induction of anaesthesia, or > 10% increase if the baseline SBP was > 180mmHg prior to induction. Purposeful logistical regression was used to explore variables associated with post-PHEA critical hypertension in a multivariable model. Data are reported as number (percentage), and odds ratio (OR) with 95% confidence interval (95%CI). 30,744 patients were attended by HEMS during the study period; 2161 received PHEA and 1355 patients were included in the final analysis. 161 (11.9%) patients had one or more new episode(s) of critical hypertension ≤ 10 min post-PHEA. Increasing age (compared with 16–34 years): 35–54 years (OR 1.76, 95%CI 1.03–3.06); 55–74 years (OR 2.00, 95%CI 1.19–3.44); ≥75 years (OR 2.38, 95%CI 1.31–4.35), pre-PHEA Glasgow Coma Scale (GCS) motor score four (OR 2.17, 95%CI 1.19–4.01) and five (OR 2.82, 95%CI 1.60–7.09), patients with a pre-PHEA SBP > 140mmHg (OR 6.72, 95%CI 4.38–10.54), and more than one intubation attempt (OR 1.75, 95%CI 1.01–2.96) were associated with post-PHEA critical hypertension. Delivery of PHEA to seriously injured trauma patients risks haemodynamic fluctuation. In adult trauma patients undergoing PHEA, 11.9% of patients experienced post-PHEA critical hypertension. Increasing age, pre-PHEA GCS motor score four and five, patients with a pre-PHEA SBP > 140mmHg, and more than intubation attempt were independently associated with post-PHEA critical hypertension.
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