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首页> 外文期刊>Emergency medicine journal: EMJ >Assessment of hypovolaemic shock at scene: Is the PHTLS classification of hypovolaemic shock really valid?
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Assessment of hypovolaemic shock at scene: Is the PHTLS classification of hypovolaemic shock really valid?

机译：现场低血容量性休克的评估：低血容量性休克的PHTLS分类真的有效吗？

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Objective: Validation of the classification of hypovolaemic shock suggested by the prehospital trauma life support (PHTLS) in its sixth student course manual. Methods: Adults, entered into the TraumaRegister DGU? database between 2002 and 2011, were classified into reference ranges for heart rate (HR), systolic blood pressure (SBP) and Glasgow coma scale (GCS) according to the PHTLS classification of hypovolaemic shock. First, patients were grouped by a combination of all three parameters (HR, SBP and GCS) as suggested by PHTLS. Second, patients were classified by only one parameter (HR, SBP or GCS) according to PHTLS and alterations in the remaining two parameters were assessed. Furthermore, subgroup analysis for trauma mechanism and traumatic brain injury (TBI) were performed. Results: Out of 46 689 patients, only 12 432 (26.5%) could be adequately classi fied according to PHTLS if a combination of all three criteria was assessed. In TBI patients, only 12.2% could be classified adequately, whereas trauma mechanism had no significant influence. When patients were grouped by HR, there was only a slight reduction in SBP. When grouped by SBP, GCS dropped from 14 to 8, while no significant tachycardia was observed in any group. In patients with a GCS less than 12, HR was unaltered whereas SBP was slightly reduced to 114 (±42) mm Hg. On average, GCS in TBI patients was lower within all shock groups. In penetrating trauma patients, changes in HR and SBP were more distinct, but still less than predicted by PHTLS. Conclusions: The PHTLS classification of hypovolaemic shock displays substantial deficits in adequately risk-stratifying trauma patients.
机译：目的：验证院前创伤生命支持（PHTLS）在其第六本学生课程手册中提出的血容量减少性休克的分类。方法：成人，进入TraumaRegister DGU吗？数据库在2002年至2011年之间，根据低血容量性休克的PHTLS分类分为心率（HR），收缩压（SBP）和格拉斯哥昏迷量表（GCS）的参考范围。首先，按照PHTLS的建议，通过所有三个参数（HR，SBP和GCS）的组合对患者进行分组。其次，根据PHTLS仅根据一个参数（HR，SBP或GCS）对患者进行分类，并评估其余两个参数的变化。此外，进行了创伤机制和脑外伤（TBI）的亚组分析。结果：在46 689例患者中，如果同时评估所有三个标准，则仅12 432例（26.5％）可以根据PHTLS进行充分分类。在TBI患者中，只有12.2％的患者可以被充分分类，而创伤机制没有明显的影响。按HR对患者进行分组时，SBP仅略有降低。当按SBP分组时，GCS从14下降到8，而在任何组中均未观察到明显的心动过速。 GCS小于12的患者，HR不变，而SBP略降至114（±42）mm Hg。平均而言，在所有休克组中，TBI患者的GCS均较低。在穿透性创伤患者中，HR和SBP的变化更为明显，但仍比PHTLS预测的少。结论：低血容量性休克的PHTLS分类在充分分层风险的创伤患者中显示出明显的缺陷。

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