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在平衡的复苏中,冷凝液在哪里适合? 一项对2,117名出血患者的评估,使用基于粘弹性的复苏
Jan-Michael Van Gent1, Thomas W Clements, Jennifer M Gurney
1From the Department of Surgery (J.-M.V.G., T.W.C., B.A.C.), McGovern Medical School, University of Texas Health Science Center, Houston; and Joint Trauma System (J.-M.V.G., J.M.G.), Defense Health Agency, Joint Base San Antonio-Fort Sam Houston, Texas.
The journal of trauma and acute care surgery
|April 18, 2025
概括
在创伤患者的全血 (WB) 复苏中,使用粘弹性测试 (VET) 指示 cryoprecipitate 晚于组件疗法. 这表明,在没有职业教育和培训的中心,调整WB协议的冷沉度值.
科学领域:
- 创伤的复苏创伤的复苏
- 治疗出血的管理方法
- 血液产品的利用 血液产品的利用
背景情况:
- 在创伤中经验性的冷沉积物缺乏生存益处.
- 大规模输血协议可能受益于特定的冷沉积物比率.
- 粘弹性测试 (VET) 指导了冷沉积物和全血 (WB) 输血.
研究的目的:
- 用于描述输血比率,当冷沉积物被VET表示时.
- 评估全血 (WB) 对这些比率的影响.
- 为了比较WB复苏与只有组件的策略.
主要方法:
- 对接受紧急血液制品的成年创伤患者的回顾性分析.
- 兽医和医学技术 (VET) 连续使用,以指导冷流体输血.
- 红细胞 (RBC),血,血小板和冷沉积物比率的计算.
- 接受WB治疗的患者与仅成分治疗的患者的比较.
主要成果:
- 在2,117名患者中,总生存率为77%.
- 中位数4小时的红血细胞/血/血小板/冷沉积物比率为9:9.5:1.3:1.
- 与组件疗法相比,WB复苏延迟了冷凝剂的需要 (10:9.5:1.7:1对比7:6:1:1).
结论:
- 与组件相比,VET引导的复苏显示了与WB相比,WB的后期冷沉使用.
- 对于没有VET的中心,考虑在7个RBC/血单位或10个WB单位后进行冷沉.
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