医院前血液制品对意外生存的影响:一个多机构研究的研究
Thomas W Clements1, Jan-Michael Van Gent, Andrea Krzyzaniak
1From the Division of Acute Care Surgery, Department of Surgery (T.W.C., J.-M.V.G., B.A.C.), Red Duke Trauma Institute, University of Texas Health Science Center at Houston and The Mcgovern School of Medicine, Houston, Texas; and Division of Trauma, Acute Care Surgery, and Surgical Critical Care (A.K., B.C., A.C., M.M., M.S., K.A.P.), Scripps Mercy Hospital, San Diego, California.
The journal of trauma and acute care surgery
|May 2, 2025
概括
在创伤患者的医院前输血产品 (PHBPT) 改善了冲击指数,增加了意外的幸存者. 目前的生存模型可能会低估PHBPT的好处,因为它依赖于生命信号的到来.
科学领域:
- 创伤护理研究 创伤护理研究
- 紧急医疗 紧急医疗
- 预测模型的预测建模.
背景情况:
- 对于受伤患者,生存预测模型通常使用到达生命体征,而不是医院前 (PH) 数据.
- 医院前输血产品 (PHBPT) 与运输期间改善的冲击指数 (SI) 有关.
- 该研究旨在评估PHBPT对预期和观察到的生存时间的影响.
研究的目的:
- 评估医院前输血产品 (PHBPT) 对创伤患者生存预测的影响.
- 根据创伤严重性得分 (TRISS) 的预期生存时间与观察到的生存时间进行比较.
- 确定与接受PHBPT和未接受PHBPT的创伤患者意外存活相关的因素.
主要方法:
- 来自两个1级创伤中心的1,139名创伤患者的回顾性审查 (2017年7月至2021年7月).
- 基于血液复苏时间的患者分层:PHBPT与医院内输血.
- 多变量逻辑回归分析以确定意外生存的预测因素.
主要成果:
- 接受PHBPT治疗的患者的伤害严重程度 (ISS) 和现场SI.都更高.
- 在到达急诊室时,PHBPT与SI的显著改善有关.
- 接受PHBPT的患者有更高的意外幸存率 (13%与PH TRISS的4%,15%与到达TRISS的7%).
结论:
- 医院前输血产品可以改善休克指数,增加创伤患者意外幸存率.
- 当前死亡率预测模型中使用的急诊室生命体征可能无法完全解释PHBPT的好处.
- 研究结果表明,需要重新考虑将医院前干预措施纳入生存预测算法.
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