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量化整体血液对创伤患者死亡率的好处,需要突发性腹腔切除术

Daniel Lammers¹, Richard Betzold, John McClellan

¹From the Center for Injury Science, Heersink School of Medicine (D.L., R.B., S.H., E.B., Z.H., J.K., J.O.J., J.B.H.), University of Alabama at Birmingham, Birmingham, Alabama; Division of Acute Care and Trauma Surgery (J.M., M.E.), University of North Carolina, Chapel Hill, North Carolina; Department of General Surgery (J.B.), Madigan Army Medical Center, Tacoma, Washington; and Department of Trauma and Acute Care Surgery (P.H.), Chippenham Hospital, Richmond, Virginia.

The journal of trauma and acute care surgery

|May 1, 2024

概括

在创伤复苏中,全血 (WB) 输血显著降低了早期死亡率. 在最初的复苏期内输血的WB的比例很高,显示4小时和24小时死亡率降低的概率为99%.

科学领域:

创伤复苏科学创伤复苏科学
输血医学输血医学
紧急医疗紧急医疗

背景情况:

全血 (WB) 输血在创伤护理中越来越多地使用.
有证据表明,在大量输血协议中,WB对死亡率有好处.
最佳的世界银行实践需要进一步调查.

研究的目的:

评估创伤患者在初始复苏期间输血的WB比例与早期死亡率之间的关联.
为了比较高WB比率和低WB比率的复苏策略之间的结果.

主要方法:

重度受伤患者的回顾性分析,需要在第一个小时内出现腹腔切除术和显著的红细胞产品.
患者被分为高比率 (≥50%WB) 和低比率 (<50%WB) 的队列.
多级别贝叶斯回归分析,以确定早期死亡的概率和风险比率.

主要成果:

高WB比率队列与低WB比率队列相比,在4小时和24小时内死亡率降低的概率为99%.
94%和88%的死亡率相对风险降低至少50%的概率与分别在4小时和24小时进行WB主导的复苏有关.
分析了266名患者 (81%是男性,平均年龄为36,61%是穿透性损伤,平均ISS为30).

结论:

在初始复苏期间,优选输血WB可能比改善早期死亡率的成分主导策略优越.
在WB主导的复苏中,在降低4小时和24小时死亡率方面表现出99%的优势概率.
建议进行前性随机试验,以证实这些发现.

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