在血液短缺期间严重受伤的患者的数据驱动的输血门
Darwin Ang1, Samir M Fakhry2, Dorraine D Watts2
1Department of Surgery, University of South Florida, Tampa, Florida; College of Medicine, University of Central Florida, Orlando, Florida; Department of Trauma, HCA Florida Ocala Hospital, Ocala, Florida.
The Journal of surgical research
|June 18, 2023
概括
在血液短缺期间,修改大规模输血协议 (MTP) 以基于年龄的体积限制. 超过这些值会显著增加死亡风险,强调需要谨慎地使用血液产品.
科学领域:
- 创伤外科 手术 创伤外科
- 输血医学 输血医学
- 医疗保健管理的管理
背景情况:
- 由于COVID-19流行病等事件而加剧的血液产品短缺,对需要输血的患者构成重大风险.
- 在稀缺条件下,机构可能需要在大量输血协议 (MTP) 期间实施明智的血液管理策略.
研究的目的:
- 为在严重血液供应限制期间修改MTP提供数据驱动的指导.
- 根据年龄和风险因素,建立基于证据的MTP数量门.
主要方法:
- 47个创伤中心 (TC) 的回顾性队列研究使用统一的MTP协议 (2017-2019).
- 分析死亡率作为输血量和患者年龄的函数.
- 估计血红蛋白值和无用度的措施.
- 使用多变量和等级回归进行风险调整分析.
主要成果:
- 拟议的MTP最大体积门:60个单位 (16-30岁),48个单位 (31-55岁),24个单位 (>55岁).
- 死亡率在30-36%的值以下,在超过时翻倍至67-77%.
- 医院前的心脏骤停和不反应的学生是徒劳的指标;在医院的因素包括脑CT和心肺骤停的中线转移.
结论:
- 建立基于年龄的MTP门可以在短缺期间维持血液供应.
- 在有限的血液供应条件下,在MTP修改中应考虑关键风险因素.
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