根据最新的指导方针,含血的复苏与输血相关的急性肺损伤无关
Desiree N Pinto1, Caitlin Mehta2, Edward J Kelly3
1Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia; Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia.
The Journal of surgical research
|November 13, 2024
概括
在严重烧伤患者中,含血复苏 (PIR) 并没有导致输血相关的急性肺损伤 (TRALI). 早期PIR启动没有显示增加液体复苏需求,这表明燃烧冲击管理的安全替代方案.
科学领域:
- 关键护理医学 关键护理医学
- 创伤外科 手术 创伤外科
- 输血医学 输血医学
背景情况:
- 血综合复苏 (PIR) 使用新鲜冷的血与结晶体一起用于烧伤冲击,比其他合体具有潜在的优势.
- 然而,与输血相关的急性肺损伤 (TRALI) 有关的担忧需要进行彻底的安全评估.
- 本研究评估了使用更新的共识定义在严重烧伤患者中与PIR相关的TRALI风险.
研究的目的:
- 在严重烧伤患者中评估PIR和TRALI之间的关联.
- 根据PIR启动时间 (早期与晚期) 来比较复苏量和结果.
主要方法:
- 在2018年至2022年期间接受PIR的烧伤患者的回顾性评估.
- TRALI评估包括监测急性低氧症,肺和PIR后的呼吸系统变化.
- 在早期 (0-8小时) 和晚期 (8-24小时) PIR启动之间,液体复苏体积和患者结果的比较.
主要成果:
- 在包括的88名患者中,没有一个根据更新的定义发展出TRALI (I或II型).
- 早期的PIR (n=39) 与较晚的PIR (n=49,26.0%) 相比,与更高的全体表面积 (TBSA) 烧伤率 (36.3%) 相关.
- 虽然预测的24小时复苏量在早期PIR中较高,但观察到的24小时体积 (cc/kg/%TBSA) 在各组之间没有显著差异.
结论:
- 更新的加拿大血液服务共识定义表明,在接受PIR的严重烧伤患者中没有TRALI的发展.
- 较早启动PIR与增加的液体复苏需求无关,即使在烧伤表面面积较大的患者中也是如此.
- 需要进一步的研究,以充分阐明PIR在燃烧管理中的风险和益处.
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