在需要输血的固体器官损伤患者中,静血程序与比观察更好的生存率有关
Jessicah A Respicio1, John Culhane1
1Department of Trauma and Surgical Critical Care, St. Louis University Hospital, St. Louis, MO, USA.
Journal of emergencies, trauma, and shock
|August 16, 2023
概括
选择性非手术治疗 (NOM) 是粗固体器官损伤 (SOI) 的标准. 这项研究发现,对SOI患者的输血不排除NOM安全性,血管栓塞改善了生存率. 拉皮切除术可能适用于输血患者.
科学领域:
- 创伤外科 手术 创伤外科
- 手术重症监护手术重症监护
- 紧急医疗 紧急医疗
背景情况:
- 选择性非手术治疗 (NOM) 是对粗固体器官损伤 (SOI) 的标准护理.
- 血动力学不稳定性是NOM的禁忌,但输血作为不稳定性指标的作用尚不清楚.
- 这项研究评估了在接受血液输血的SOI患者中NOM的安全性和结果.
研究的目的:
- 为了确定输血是否是非手术治疗 (NOM) 的禁忌,在患有体固体器官损伤 (SOI) 的患者.
- 在输血SOI患者中,比较NOM和手术干预 (拉巴切除术,血管栓塞) 之间的死亡率.
- 在需要输血的SOI患者中确定与生存相关的因素.
主要方法:
- 使用国家创伤数据库 (2017-2019) 进行回顾性队列研究.
- 包括患有肝脏,脏和脏损伤的患者.
- 输血患者中NOM,腹腔切除和血管栓塞之间的死亡率的比较,使用基平方和考克斯比例危险回归.
主要成果:
- 在20569名输血SOI患者中,只有腹腔切除术与死亡没有显著的关联 (OR0.93),而只有栓塞 (OR0.27) 和两种手术 (OR0.48) 与死亡率的降低有关.
- 拉皮切除术显示,接受>1单位红血细胞 (PRBCs) 的患者的生存与独立关联.
- 血管栓塞独立地与整个队列的生存有关,包括输血患者.
结论:
- 在SOI患者中,需要输血的需要应被认为是不稳定的指标,可能需要进行腹腔切除术.
- 血管栓塞在输血和非输血SOI患者中都显示出保护性生存关联,支持其使用.
- 非手术治疗可能是选择输血SOI患者的安全选择,特别是在与血管栓塞结合时.
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