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Abstract：
Introduction In polytrauma patients, it is crucial to identify the severity of the injuries to ensure patient safety and survival. Polytrauma leads to hypotension and hypoperfusion, which results in an anaerobic metabolism with acidosis and a decrease in base excess. Thus, blood lactate levels above a certain threshold indicate the existence of global tissue hypoxia, which is a precursor to shock and multiple organ dysfunction syndrome (MODS). The serum lactate and base deficit (BD) levels are used in polytrauma patients as measures of damage severity and resuscitation endpoints and as a way to evaluate therapy efficacy and to predict outcomes. Thus, arterial blood gas analysis is of great value in assessing the status and prognosis of patients with polytrauma. There are few comparative studies on the predictive values of these markers in trauma patients. To determine which measure can more accurately predict the prognosis of polytrauma patients, the present study investigated the predictive values of mortality of these indicators for mortality within 48 hours of admission to the emergency room (ER) in patients with polytrauma. Methods This prospective study was designed for a single tertiary care center in northern India. We included 90 patients with polytrauma who were between the ages of 18 and 70 years, with the exception of pregnant women, who presented to the ER within six hours of injury with an injury severity score (ISS) >16, serum lactate level >2.0 mmol/L, and BD -4.0 mEq/L at the time of admission. If the patient\'s ISS was >16 at the time of ER presentation, arterial blood samples were drawn to determine the serum lactate and BD level at the time of admission and at 12, 24, and 48 hours intervals after ER admission. The primary outcome was the change in serum lactate and BD level in polytrauma. The secondary outcomes were an association of serum lactate and BD with mortality and the correlation between serum lactate with the BD and ISS with mortality of polytrauma patients. The timing of all outcome assessments was at 48 hours after each patient\'s ER admission. Results Lactate clearance from 0-12 hours (t = 2.28, p <0.05), 0-24 hours (t = 6.01, p <0.001), and 0-48 hours (t = 7.98, p <0.001) and a correction in BD from 0-24 (t = 2.68, p <0.01 ) and 0-48 hours (t = 5.46, p <0.001) were significantly higher in nonsurvivors as compared with survivors. In survivors and nonsurvivors, mean serum lactate levels (2.46 ± 1.46 versus 4.15 ± 2.99, t = 3.31, p <0.001, 95%Cl) and mean BD (-3.17 ± 2.58 versus -6.5 ± 4.91, t = 3.86, p <0.001, 95%CI) had a statistically significant difference. The serum lactate and BD levels at time of ER admission (r L0, BD0 = -0.765, p <0.01) and 48 hours after ER admission (r L48, BD 48 = -0.652, p <0.001) were highly negatively correlated. Conclusion In polytrauma patients, serum lactate and BD are simple, quick, and independent biochemical predictors of 48-hour mortality, and this single arterial blood test would thereby improve decision-making for resuscitation effectiveness. Prolonged lactate and BD normalization time were associated with higher mortality. Serum lactate and BD are negatively correlated. A higher ISS at admission was associated with a higher incidence of mortality in polytrauma patients.
摘要：
介绍多发性创伤患者，确定受伤的严重程度以确保患者的安全和生存至关重要。多发性创伤导致低血压和低灌注，导致酸中毒的厌氧代谢和碱过量的减少。因此，血乳酸水平高于一定阈值表明存在整体组织缺氧，这是休克和多器官功能障碍综合征（MODS）的前兆。在多发性创伤患者中使用血清乳酸和碱缺陷（BD）水平作为损害严重程度和复苏终点的量度，并作为评估治疗效果和预测结果的一种方法。因此，动脉血气分析对评估多发伤患者的病情和预后具有重要价值。关于这些标志物在创伤患者中的预测价值的比较研究很少。为了确定哪种措施可以更准确地预测多发性创伤患者的预后，本研究调查了这些指标对多发性创伤患者急诊(ER)48小时内死亡率的预测价值.方法这项前瞻性研究是为印度北部的一家三级护理中心设计的。我们纳入了90名年龄在18至70岁之间的多发性创伤患者，除了孕妇,在损伤后6小时内出现ER，损伤严重程度评分（ISS）>16，血清乳酸水平>2.0mmol/L，入院时BD-4.0mEq/L。如果患者在急诊室就诊时的ISS>16，在入院时以及ER入院后12,24和48小时时抽取动脉血样测定血清乳酸和BD水平.主要结果是多发伤患者血清乳酸和BD水平的变化。次要结局是血清乳酸和BD与死亡率的相关性，以及血清乳酸与BD和ISS与多发性创伤患者死亡率的相关性。所有结果评估的时间均为每位患者的ER入院后48小时。结果乳酸清除率从0-12小时（t=2.28，p<0.05），0-24小时（t=6.01，p<0.001），0-48小时（t=7.98，p<0.001）和0-24小时（t=2.68，p<0.01）和0-48小时（t=5.46，p<0.001）的BD校正显着高于非幸存者。在幸存者和非幸存者中，平均血清乳酸水平（2.46±1.46对4.15±2.99，t=3.31，p<0.001，95％Cl）和平均BD（-3.17±2.58对-6.5±4.91，t=3.86，p<0.001，95CI）具有统计学上的显着差异。ER入院时（rL0，BD0=-0.765，p<0.01）和ER入院后48小时（rL48，BD48=-0.652，p<0.001）的血清乳酸和BD水平呈高度负相关。结论在多发性创伤患者中,血清乳酸和BD很简单，快,和48小时死亡率的独立生化预测因子，这种单动脉血液检查将改善复苏效果的决策。乳酸和BD恢复正常时间延长与较高的死亡率相关。血清乳酸与BD呈负相关。入院时ISS较高与多发伤患者死亡率较高相关。
