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对创伤患者超大规模输血的回顾性研究:是否有价值,之后额外的输血是徒劳的?

Frank R Major¹, Trevor A Pickering², Kristen Stefanescu¹

¹From the Department of Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, California.

Anesthesia and analgesia

|May 30, 2025

概括

在创伤患者中,超大规模输血 (UMT) 与较高的死亡率和并发症有关. 虽然UMT增加了死亡风险,但这项研究没有确定特定的红细胞 (RBC) 输血门,以证明限制输血是合理的.

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:

出血是创伤患者可预防死亡的主要原因.
血液短缺可能需要考虑输血值的徒劳性.
超大规模输血 (UMT) 被定义为24小时内≥20个红细胞 (RBC) 单位.

研究的目的:

检查与UMT (≥20个红细胞单位/24小时) 相关的结果.
为了确定是否存在输血门,超出额外的输血是徒劳的.
评估UMT对死亡率,停留时间,机械通风和并发症的影响.

主要方法:

在美国7个I级创伤中心对成人创伤患者 (2016-2022) 的回顾性分析.
在24小时内接受UMT的患者与<20个RBC单位的患者的比较.
分段后勤回归以确定红细胞单元对死亡率的平原效应.

主要成果:

在UMT患者 (10.3%) 中,24小时和住院死亡率显著增加.
UMT与增加的并发症和多器官衰竭有关.
超过45个红细胞单位,死亡风险显著增加;进一步输血并没有提高生存概率.

结论:

UMT与创伤中更糟糕的结果和更高的死亡率有关.
没有确定任何特定的红细胞输血门,以仅基于这些数据来证明限制输血的合理性.
需要进一步的研究来确定在重症创伤护理中的输血限制.

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