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在创伤中进行全血和血液成分复苏:与死亡率的相互作用和关联
Ander Dorken-Gallastegi1, Phillip C Spinella2, Matthew D Neal2
1Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
Annals of surgery
|May 6, 2024
概括
全血 (WB) 复苏,WB与总输血量 (WB:TTV) 的较高比例,以及平衡的血液成分输血与创伤患者的死亡率降低有关. 这项研究强调了WB在重症监护复苏方案中的好处.
科学领域:
- 创伤复苏 创伤复苏 复苏
- 输血医学 输血医学
- 紧急医疗 紧急医疗
背景情况:
- 全血 (WB) 越来越多地用于民用创伤复苏,通常与血液成分一起使用.
- 联合WB和组件输血策略对患者结局的具体相互作用和影响仍然不清楚.
研究的目的:
- 调查全血 (WB) 和血液成分复苏策略与创伤患者的死亡率之间的关系.
- 评估WB与总输血量 (WB:TTV) 的比例对死亡率的影响.
- 评估平衡血液成分输血协议与WB联合对生存的影响.
主要方法:
- 在4小时内接受≥4单位红血细胞和/或白血细胞的成年创伤患者的分析中,冲击指数>1.
- 利用美国外科医生学院创伤质量改进计划数据库在501个美国创伤中心.
- 采用多变量分析来评估输血策略与死亡率之间的关联.
主要成果:
- 与单元复苏相比,WB复苏与较低的4小时,24小时和30天死亡率有关.
- 较高的WB:TTV比率与死亡率的降低有显著的关联,每10%的增加将4小时死亡率的几率降低13%.
- 平衡的血液成分输血,当与WB结合时,显著降低了4小时,24小时和30天死亡率的几率.
结论:
- 全血复苏,较高的WB:TTV比率和与WB一起的平衡成分输血与严重受伤的创伤患者的生存率提高有关.
- 这些发现支持将WB和平衡组件策略整合到震惊患者的大规模输血协议中.
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