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血液制品在紧急复苏胸切除术中的使用:全国性的分析
Vahe S Panossian1, Ikemsinachi C Nzenwa2, Emanuele Lagazzi2
1Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA. Electronic address: https://twitter.com/VahePanossian.
Surgery
|March 29, 2025
概括
紧急复苏胸腔切除术的生存率很低,特别是对于没有生命迹象的重创伤. 血液制品的使用应优先考虑穿透创伤患者和有生命迹象的患者,以优化生存结果.
科学领域:
- 创伤外科 手术 创伤外科
- 紧急医疗 紧急医疗
- 关键的护理关键的护理
背景情况:
- 紧急复苏胸腔切除术 (ERT) 的存活率因受伤机制和生命体征的存在而有很大差异.
- 血液产品短缺需要对ERT患者的输血实践进行检查.
- 这项研究调查了ERT患者的血液产品利用率和生存率.
研究的目的:
- 为了分析在接受紧急复苏胸腔切除术的患者中使用血液产品.
- 在这个患者队列中,将输血产品与生存结果相关联.
- 为创伤护理中血液制品的资源分配提供信息.
主要方法:
- 来自美国外科医生学院创伤质量和改善计划 (2017-2019) 的1231名患者的回顾性分析 (2017-2019).
- 纳入标准:在到达医院后30分钟内接受ERT治疗.
- 测量结果:包装红细胞,血和血小板输血量,以及整体存活率.
主要成果:
- 总体存活率为7.3%. 穿透创伤与生命迹象的生存率为17.1%,接受的中位数为8.0个PRBC单位.
- 没有生命迹象的形创伤有1.1%的存活率,接受中位数为2.0个PRBC单位.
- 30个PRBC单位输血每幸存者穿透创伤有生命迹象; 485个PRBC单位每幸存者形创伤没有生命迹象.
结论:
- 对于没有生命迹象的重创伤患者的ERT几乎是徒劳的.
- 输血产品的输血对那些结果不佳的患者来说是非常资源密集的.
- 建议优先考虑输血资源,以治疗有生命迹象的穿透创伤和伤患者.
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