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危及生命的出血,定义为非创伤性严重出血中的临界管理值:一项描述性观察性研究
Luke J Matzek1,2, Andrew C Hanson3, Phillip J Schulte3
1Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Transfusion
|August 30, 2024
概括
住院患者的严重出血通常发生在创伤之外. 临界管理值 (CAT) 确定了这一点,在非创伤环境中,死亡率接近20%.
科学领域:
- 关键护理医学 关键护理医学
- 管理出血 管理出血
- 输血医学 输血医学
背景情况:
- 在住院患者中,最严重的出血发生在创伤之外.
- 之前对严重出血和大量输血的评估主要集中在创伤性出血上.
- 了解非创伤性关键出血对于改善患者的治疗结果至关重要.
研究的目的:
- 在非创伤性出血中使用临界给药值 (CAT) 描述临界出血的发生情况.
- 为未来对非创伤性出血的研究建立一个框架.
- 描述非创伤性严重出血患者的人口,临床和输血模式.
主要方法:
- 在住院期间,对符合CAT标准 (1小时内≥3单位红细胞) 的成年人进行观察性队列研究.
- 从2016年到2021年在一个学术机构收集的数据.
- 在≥4小时输血间隔之前,从第一个合格的红血细胞单位到最后一个异构单位定义了一个CAT插曲.
主要成果:
- 2433名患者出现了严重出血,主要是在手术室 (71.1%) 和ICU (20.8%).
- 输血的红血细胞单位中位数为5个 (范围为4-8个),总异构单位中位数为9个.
- 医院死亡率为19.2%,在72.7%的患者中,脱血是24小时内死亡的原因.
结论:
- 临界管理值 (CAT) 可以在非创伤环境中识别临界出血.
- 非创伤性关键出血的显著死亡率约为20%.
- 需要进一步的研究来开发针对非创伤性出血的有针对性的干预措施.
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