意图与执行:未能在出血创伤患者中实现平衡的复苏
Jan-Michael Van Gent1,2, Thomas W Clements1, Jeremy W Cannon3,4
1Department of Surgery at The McGovern Medical School at the University of Texas Health Science Center, Houston, TX.
Annals of surgery
|June 17, 2025
概括
在近60%的创伤患者中,没有达到平衡的复苏比率 (红细胞:新鲜冷血:血小板). 达到这些比率,特别是全血 (WB),改善了严重受伤患者的生存率.
科学领域:
- 创伤复苏的复苏治疗方法
- 治疗出血的管理方法
- 血液产品输血协议 输血协议
背景情况:
- 2014年"TQIP最佳实践"建议使用1:1:1的RBC:FFP:PLT比率进行平衡的复苏.
- 之前的一项随机试验表明,创伤患者接受1:1:1平衡复苏的死亡率降低.
- 这些指南在临床实践中的采用和评估仍然有限.
研究的目的:
- 评估在受伤后的最初4小时内遵守平衡复苏比率 (RBC:FFP和RBC:PLT).
- 调查使用全血 (WB) 对实现这些平衡的复苏率的影响.
- 评估复苏率与患者死亡率之间的关联.
主要方法:
- 一项前性的多中心观察队列研究,涉及7个学术一级创伤中心.
- 纳入标准:需要输血和血液控制手术的受伤患者.
- 主要结局:RBC:FFP和RBC:PLT的4小时比率;排除60分钟内死亡的患者.
主要成果:
- 只有40%的患者在4小时内实现了1:1的RBC:FFP比率,23%的患者在4小时后实现了1:1的RBC:PLT比率.
- 在患者实现RBC:FFP (P<0.05) 和RBC:PLT (P<0.05) 的1:1比率的情况下,观察到较低的28天死亡率.
- 全血 (WB) 的使用显著增加了实现1:1RBC:FFP (OR 2.8) 和RBC:PLT (OR 3.4) 比率的可能性 (P<0.001).
结论:
- 在这项多机构研究中,不到50%的创伤患者接受了均衡的复苏.
- 全血 (WB) 的使用与实现平衡复苏比率的更高概率有关.
- 无法实现平衡的复苏与患者存活时间的减少有关.
相关概念视频
Cardiopulmonary Resuscitation I: Adult
99
Cardiopulmonary resuscitation, or CPR, is a life-saving emergency procedure performed when a person's heart has stopped beating or they are no longer breathing. The foundation of CPR is Basic Life Support (BLS), which focuses on the early recognition of cardiac arrest, the immediate start of high-quality chest compressions, and the timely use of an automated external defibrillator (AED).Assessing Responsiveness and Checking the Carotid PulseWhen approaching an unresponsive person, first ensure...
99
Cardiopulmonary Resuscitation IV: Pharmacological Management
84
Pharmacologic intervention is crucial in treating cardiac arrest patients during ACLS or Advanced Cardiovascular Life Support. The ACLS algorithms guide the administration of specific drugs based on the patient's cardiac arrest rhythm, which includes pulseless ventricular tachycardia (VT), ventricular fibrillation (VF), asystole, and pulseless electrical activity (PEA).EpinephrineIndication: Epinephrine is the first-line drug for all cardiac arrest rhythms.Mechanism of Action: Epinephrine...
84
Blood Pressure Imbalances and Circulatory Shock
1.0K
Disorders affecting blood volume, vascular tone, or vascular function can disrupt vascular homeostasis, including conditions like hypertension, hemorrhage, and shock.
Blood Pressure: Hypertension and Hypotension
Normal blood pressure is 120/80 mm Hg. Elevated blood pressure is 120-129/under 80 mm Hg. Hypertension, warranting treatment at 130/80 mm Hg, is often asymptomatic and can lead to severe cardiovascular events, aneurysms, peripheral arterial disease, chronic renal disease, or cardiac...
Blood Pressure: Hypertension and Hypotension
Normal blood pressure is 120/80 mm Hg. Elevated blood pressure is 120-129/under 80 mm Hg. Hypertension, warranting treatment at 130/80 mm Hg, is often asymptomatic and can lead to severe cardiovascular events, aneurysms, peripheral arterial disease, chronic renal disease, or cardiac...
1.0K
Acute Respiratory Failure-II
388
Type I Respiratory Failure, or hypoxemic respiratory failure, occurs when the partial pressure of oxygen (PaO2) in arterial blood falls below 60 mmHg while breathing room air without a corresponding increase in arterial carbon dioxide levels (PaCO2). This condition highlights a significant impairment in the lungs' capacity to oxygenate the blood.
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
388
Flail Chest-II
242
Managing flail chest, a condition characterized by a segment of the chest wall moving independently from the rest of the thoracic cage, requires a comprehensive approach. It includes a thorough assessment of the patient's condition, a diagnostic evaluation to determine the extent of the injury, and the implementation of appropriate medical interventions tailored to the individual's needs.
Assessment:
1. Clinical Evaluation:
History:
Assessment:
1. Clinical Evaluation:
History:
242


