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纤维素早期严重创伤研究 (FEISTY):来自澳大利亚多中心随机对照试点试验的结果
James Winearls1,2,3,4, Martin Wullschleger5, Elizabeth Wake5
1Intensive Care Unit, Gold Coast University Hospital, Gold Coast, QLD, Australia.
概括
纤维素缩物 (FC) 与冷沉积物 (Cryo) 相比,在创伤患者中显著加快纤维素替代. 这项研究发现,FC的输送速度要快得多,尽管这两种产品都有效地恢复了纤维素素水平.
科学领域:
- 创伤的复苏创伤的复苏
- 血液静止和血栓形成
- 关键护理医学 关键护理医学
背景情况:
- 出血是严重创伤中死亡的主要原因.
- 纤维素素对于创伤性出血期间的血液静止至关重要.
- 建议早期用纤维素缩物 (FC) 或冷沉积物 (Cryo) 替代纤维素素,但对它们进行比较的证据有限.
研究的目的:
- 在严重受伤的创伤患者中,使用FC与Cryo进行纤维素替代的时间与严重出血和低纤维素生成血的时间进行比较.
- 评估FC和冷对血纤维素水平和临床结果的影响.
- 为未来关于最佳纤维素原替代策略的试验设计提供信息.
主要方法:
- 一个多中心控制的试点试验随机分配成年创伤患者出血接受FC或冷.
- 纤维素替代被FIBTEM A5测量指导.
- 主要结局是开始纤维素替代治疗的时间;次要结局包括纤维素水平和临床结局的变化.
主要成果:
- 与冷 (中位数60分钟) 相比,使用FC (中位数29分钟) 的纤维素替代物更快 (P = 0.0001).
- 无论是FC还是Cryo,都有效地恢复了低纤维素基因患者的纤维素水平.
- 输血要求,液体复苏和血栓栓塞并发症在各组之间相似;整体死亡率为15.3%.
结论:
- 纤维素缩物能够显著更快的纤维素替代在创伤患者严重出血和低纤维素血比冷凝.
- 虽然这两种产品都会增加纤维素素水平,但对于创伤性出血的最佳选择仍在研究中.
- 结果支持需要进行更大规模的试验,以确定纤维激素替代策略的以患者为中心的结果.
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