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识别受伤患者从全血输血中受益:对患者存活率的影响分解分析

Crisanto M Torres^1,2, Allan E Stolarski¹, Kelly M Kenzik^1,2

¹Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA.

|July 28, 2025

概括

全血 (WB) 输血可能会改善创伤患者的生存率,这些患者患有严重的低血压. 虽然整体死亡率没有显著差异,但WB对低血压患者,特别是患有静缩血压低于70mmHg的患者显示出好处.

科学领域:

紧急医疗紧急医疗
创伤外科手术创伤外科
输血医学输血医学

背景情况:

全血 (WB) 输血越来越多地被认为是严重的创伤性出血.
将WB与组件疗法 (CT) 进行比较的证据在最佳使用方面仍然存在矛盾.
了解影响WB有效性的患者特定因素至关重要.

研究的目的:

在成年创伤患者中,比较全血 (WB) 与成分治疗 (CT) 的有效性.
为了确定可能预测WB输血的益处的临床特征.
量化患者因素对WB和CT死亡率差异的影响.

主要方法:

在民用创伤中心对2020-2021年成人创伤患者的回顾性评估.
包括在急诊室到达后四小时内接受WB或CT的患者.
对临床参数和效果分解的分析,以评估WB与CT的影响.

主要成果:

在整个队列中,WB和CT之间的24小时死亡率没有显著差异 (aOR 0.85).
抵达时患有低血压的患者在WB治疗时死亡率显著降低.
这种益处在患有静缩血压<90 mmHg (aOR 0.72) 和<70 mmHg (aOR 0.64) 的患者中显著.

结论:

在创伤中WB输血的有效性受患者临床特征的影响.
抵达低血压是一个关键因素,解释了13%的观察到的死亡率差异有利于WB.
未来的试验是必要的,以确定最佳的患者选择WB复苏.

关键词:

输血实践 (成年人) 的做法输血实践包括 (手术) 血静止.

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