Shock Index Correlates with Extravasation on Angiographs of Patients with Hemorrhage in the Head and Neck Region

在頭頸部出血的病人進行血管攝影：使用休克指數與對比劑滲漏建立關聯性

許立生(Li-Sheng Hsu) ； 翁旭惠(Hsu-Huei Weng) ； 廖玉山(Yu-San Liao) ； 楊博堯(Bor-Yau Yang) ； 蔡元雄(Yuan-Hsiung Tsai) ； 許勝榮(Sheng-Lung Hsu)

《中華放射線醫學雜誌》 33卷2期 (2008/06) Pp. 57-63

摘要

休克指數是以每分鐘心跳數除以收縮壓（單位：毫米汞柱）而得，它是左心室功能異常的敏感指標。升高的休克指數與危急的病人較差的預後有關，同時也與腸胃道出血、子宮外孕破裂、肝臟鈍傷、脾臟外傷、敗血症和肺栓塞有關。
我們利用回溯性研究方式來分析頭頸部出血的病患與臨床資料間（休克指數、血色素、血小板、年齡）是否有關聯。42位病人（18-79歲，平均年齡55.3歲），其中32位的病因與癌症有關(76.2%)。總共進行了52次的血管攝影，22次顯示了對比劑滲漏(42.3%)，30次則沒有發現。結果顯示休克指數與對比劑滲漏有明顯的關聯性。癌症病人與非癌症病人之間，對比劑滲漏的機率則沒有差別。休克指數用來區別對比劑滲漏的取捨值為0.87（敏感性：63.6%；特異性：73.3%）。我們的結論是在頭頸部出血的病人中，對比劑滲漏與血管攝影之前的休克指數高低有關。休克指數高的病人發現對比劑滲漏的機會較高。此外，如果血管攝影檢查時沒有發現對比劑滲漏，高休克指數也可以提醒我們其他部位出血或是血管痙攣導致暫時停止出血的可能性。

並列摘要

The shock index (SI) is simply calculated as heart rate (HR; beats per minute) divided by systolic blood pressure (SBP; mmHg), and it is a sensitive indicator of left ventricular dysfunction. Persistent elevation of the SI value has been associated with poor outcome in critically ill patients, and it has been reported to be a predictor of gastrointestinal hemorrhage, ruptured ectopic pregnancy, blunt hepatic injury, splenic injury, sepsis, and pulmonary embolism. We applied univariate and multivariate logistic regression analyses to determine the relationship of the clinical findings in patients with hemorrhage in the head and neck region with angiographic evidence of extravasation. Our study population comprised 42 patients (age range, 18-79 years; average, 55.3 years), of whom 32 had cancer-related etiologies (76.2%). Of the 52 angiograms obtained, 22 showed contrast extravasation (42.3%), while 30 did not (57.7%). Clinical findings including the shock index (SI), hemoglobin (Hb) level, platelet (PLT) count and age were analyzed. The reciprocal root-transformed SI (transformed SI) correlated with the angiographic evidence of extravasation in multivariate logistic regression analysis (p ＜ 0.05). No significant difference in angiographic extravasation was observed between cancerous and noncancerous patients. There is significant difference of SI in contrast extravasation between (ICA or CCA) and ECA groups (p = 0.02). The optimal cut-off point of SI for predicting angiographic extravasation was 0.87 (sensitivity: 63.6%; specificity: 73.3%). We conclude that in patients with head and neck hemorrhage, angiographic evidence of extravasation has a modest correlation with preangiographic SI. Patients with an elevated SI would have a higher probability of angiographic extravasation. Furthermore, if bleeding focus cannot be identified at angiography, the existence of hemorrhage in other region or temporarily restricted bleeding due to vasospasm, should be considered.