單次掉血壓也可能是嚴重創傷的指標之一

Beware of Even a Single Hypotensive Blood Pressure Measurement in Trauma Patients
A single systolic BP reading less than 105 mm Hg in the emergency department portends serious injury and the potential need for immediate surgical or endovascular intervention.

Hypotension in trauma patients typically occurs after loss of 30% of total blood and, if persistent, can lead to end-organ injury resulting from hypoperfusion and uncompensated shock. In a prospective observational study at a single level I trauma center, researchers determined the systolic blood pressure (SBP) cutpoint value that best predicts the need for therapeutic surgical or endovascular procedures; 145 adult patients (77% men; 54% with blunt mechanism of injury) who had at least one SBP measurement below 110 mm Hg during initial trauma care were enrolled during a 6-month period. Exclusion criteria were transfer from another hospital, injury more than 2 hours before emergency department (ED) arrival, and isolated prehospital hypotension (below 90 mm Hg) or more than two SBP readings below 90 mm Hg in the ED.

SBP was measured manually within 10 minutes of ED arrival and then automatically at least every 5 minutes for the first 15 minutes, followed by every 15 minutes for the first hour, and then hourly thereafter. Cutpoint analysis showed that a single SBP measurement below 105 mm Hg best predicted need for immediate intervention. Patients with a single SBP measurement below 105 mm Hg, compared to those with no measurement below 105 mm Hg, were significantly more likely to undergo therapeutic intervention (38% vs. 10%), to be admitted to a surgical intensive care unit (54% vs. 25%), and to have a prolonged hospital stay (mean, 8.3 vs. 4.2 days). Other independent predictors of need for therapeutic intervention were gunshot wound mechanism of injury, higher injury severity score, and longer duration of initial resuscitation.

Comment:

This small study suggests that even a single SBP measurement below 105 mm Hg in patients with trauma should not be dismissed as erroneous. A single low reading could reflect impending shock and indicate need for aggressive management as well as therapeutic surgical or endovascular procedures.

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John A. Marx, MD, FAAEM
Published in Journal Watch Emergency Medicine July 16, 2010

Citation(s): Seamon MJ et al. Just one drop: The significance of a single hypotensive blood pressure reading during trauma resuscitations. J Trauma 2010 Jun; 68:1289.