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在创伤中严重出血的输血策略
Susan J Brunskill1,2, Arthur Disegna3, Henna Wong4
1Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK.
The Cochrane database of systematic reviews
|April 24, 2025
概括
这次审查发现很少有证据表明,不同的输血策略显著影响创伤患者的死亡率或血栓塞栓事件. 需要进一步的研究来澄清主要出血管理的最佳方法.
科学领域:
- 创伤和紧急医疗医学
- 输血医学 输血医学
- 关键的护理关键的护理
背景情况:
- 创伤是全球死亡和残疾的主要原因.
- 早期识别和治疗出血和凝血病对于创伤患者的治疗结果至关重要.
- 缺乏对输血策略的共识,阻碍了临床实践的转化.
研究的目的:
- 评估成年创伤患者大出血后24小时内开始的输血策略的益处和危害.
- 综合来自各种血液产品输血协议的随机对照试验 (RCT) 的证据.
主要方法:
- 对18项涉及5041名参与者的RCT进行系统审查.
- 搜索了多个数据库 (CENTRAL,MEDLINE,Embase) 和试验登记册.
- 使用GRADE方法评估证据确定性.
主要成果:
- 医院前血输血对24小时死亡率有不确定的影响,但与标准护理相比,30天死亡率可能没有差异.
- 医院内策略,包括冷凝剂,固定比例组分疗法 (1:1:1 血:血小板:红血细胞) 和粘弹性静血分析 (VHA),与标准或常规测试相比,死亡率或血栓塞栓事件可能没有差异.
- 对全血输血和特定成分比率的证据 (例如,1:1:1对1:1:2) 给出了不确定的或低确定性死亡率和血栓塞栓事件的发现.
结论:
- 总的来说,有限的证据表明,在创伤患者的死亡率或血栓栓塞事件方面,各种输血策略之间几乎没有差异.
- 研究中的干预和比较器的异质性限制了数据的汇集.
- 需要进一步的研究,以建立最佳的输血协议,以治疗创伤严重出血.
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