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通过直升机运输的重大创伤患者的医院前纤维素水平紧急医疗服务:确定谁可能受益
Shannon Pretty1, Domhnall O'Dochartaigh2,3, Elfriede Cross2
1Department of Emergency Medicine, University of Al-berta, Edmonton, Alberta, Canada.
概括
创伤患者的纤维素水平较低预示着不良结果. 输血后持续的低血压和急诊室到达时的高冲击指数 (SI) 是低纤维素生成血的关键指标.
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:
- 低纤维素素水平与创伤性凝血病的不良结果有关.
- 实证性纤维原体替代缺乏强有力的证据,需要早期识别有风险的患者.
- 识别与低纤维素生成血症相关的医院前变量对于有针对性的干预至关重要.
研究的目的:
- 在创伤患者的急诊室 (ED) 抵达时,识别与低纤维素生成血症相关的医院前变量.
- 为了研究输血后低血压,冲击指数 (SI) 和低纤维激素水平之间的关系.
主要方法:
- 对直升机EMS运输的创伤患者接受包装红细胞 (pRBC) 的回顾性审查.
- 主要结局:ED纤维素水平 (<1.6g/L与≥1.6g/L).
- 多变量逻辑回归分析了低血压,SI和缩血压.
主要成果:
- 第一次pRBC输血后持续的低血压与较低的ED纤维素水平显著相关 (OR = 6.6).
- 升高的ED冲击指数 (EDSI) ≥1.5与低纤维素生成血 (OR = 8.9对于EDSI ≥1.5与<1) 强烈相关.
- 输血后的低血压也与国际正常化比率 (INR) > 1.5.5 的升高相关.
结论:
- 在重创患者中,在初始输血后持续的低血压与低纤维素因子有关.
- 初始EDSI≥1.5是该人群中低纤维素生成血症的显著预测指标.
- 这些发现支持早期识别和潜在的针对性治疗创伤中的低纤维蛋白质血症.
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