目前的争议和大规模输血的进展:平衡证据和实践
Ting-Lung Lin1, Hang-Tsung Liu2, Ching-Hua Hsieh3
1Department of General Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung, 83301, Taiwan.
概括
大规模输血协议 (MTP) 通过使用平衡的血液产品比率来改善出血控制. 研究探讨粘弹性测试和全血输血,以改善创伤患者的治疗结果.
科学领域:
- 紧急医疗 紧急医疗
- 创伤外科 手术 创伤外科
- 血液学 血液学 血液学
背景情况:
- 大规模输血协议 (MTP) 对于管理严重出血至关重要,特别是在创伤中.
- 关于最佳血液产品比率,粘性弹性静血试验 (VHA) 的使用,以及全血输血存在争议.
- 军事实践影响了平民对出血管理的方法.
研究的目的:
- 审查当前的争议和大规模输血协议的进展.
- 评估关于均衡输血策略,VHA和全血使用的证据.
- 突出军事经验对民用MTPs的影响.
主要方法:
- 对当前证据和正在进行的MTP研究的文献综述.
- 分析有关血液产品比例的数据 (例如:1:1:1血:血小板:红血细胞).
- 检查粘弹性静血试验 (VHA) 和全血输血的作用.
主要成果:
- 均衡的输血策略 (大约2个小时) 1:1:1) 显示改善了早期的出血控制.
- 粘弹性测试 (TEG,ROTEM) 提供实时数据,但缺乏随机试验共识,以广泛使用.
- 由于生存效益和后勤优势,全血输血正在重新获得青.
结论:
- 均衡的输血仍然是大规模出血管理的基石.
- 包括VHA和潜在的全血在内的个性化治疗策略正在发展.
- 未来的MTP可能将整合精准医学和先进诊断以改善创伤护理.
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