背景:严重创伤患者的临界高血压与死亡率增加相关。院前急诊麻醉(PHEA)是对10%最严重受伤的患者进行的。优化氧合,通风,和脑灌注,同时避免极端的血流动力学波动是减少继发性脑损伤的基石。这项研究的目的是在三个直升机紧急医疗服务(HEMS)组织的大型区域性创伤患者数据集中报告PHEA后临界高血压的差异决定因素。
方法:对英国三个HEMS连续接受PHEA的成年创伤患者进行多中心回顾性观察研究;2015-2022年。临界高血压被定义为麻醉诱导10分钟内新的收缩压(SBP)>180mmHg,如果诱导前基线SBP>180mmHg,则增加>10%。在多变量模型中,使用有目的的后勤回归来探索与PHEA后临界高血压相关的变量。数据报告为数字(百分比),和比值比(OR),95%置信区间(95CI)。
结果:30,744名患者在研究期间接受了HEMS治疗;2161名患者接受了PHEA,1355名患者被纳入最终分析。161例(11.9%)患者出现一个或多个新的临界高血压发作≤PHEA后10分钟。年龄增长(与16-34岁相比):35-54岁(OR1.76,95CI1.03-3.06);55-74岁(OR2.00,95CI1.19-3.44);≥75岁(OR2.38,95CI1.31-4.35),Pre-PHEA格拉斯哥昏迷量表(GCS)运动评分4(OR2.17,95CI1.19-4.01)和5(OR2.82,95CI1.60-7.09),PHEA前SBP>140mmHg的患者(OR6.72,95CI4.38-10.54),一次以上的插管尝试(OR1.75,95CI1.01-2.96)与PHEA后危重高血压相关.
结论:对严重创伤患者实施PHEA有血流动力学波动的风险。在接受PHEA的成年创伤患者中,11.9%的患者经历PHEA后危重高血压。年龄增长,PHEA前GCS运动分数4和5,PHEA前SBP>140mmHg的患者,并且超过插管尝试与PHEA后危重高血压独立相关。
BACKGROUND: 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.
METHODS: 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).
RESULTS: 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.
CONCLUSIONS: 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.