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成人创伤中的全血与成分疗法:更新的系统性审查和元分析
Wesam Ibrahim1,2, Kenneth Meza Monge1, Johannes Menzel1
1Division of GI, Trauma, and Endocrine Surgery, Department of Surgery, University of Colorado, Aurora.
JAMA surgery
|March 11, 2026
概括
与组件治疗相比,全血输血显著降低了平民创伤患者的死亡率. 然而,在军事环境中没有观察到任何显著的益处,这表明需要量身定制的输血协议.
科学领域:
- 创伤护理和复苏科学 创伤护理和复苏科学.
- 输血药物 输血药物 输血药物 输血药物
- 基于证据的医学和系统性审查.
背景情况:
- 出血是可预防的创伤死亡的主要原因.
- 在创伤复苏中,全血治疗与成分治疗的比较有效性尚未得到充分证实.
- 患者群体和复苏方案的异质性使治疗决策复杂化.
研究的目的:
- 为了确定全血输血是否与组件治疗相比,在成人创伤患者中降低死亡率.
- 单独分析民用和军事环境的结果.
- 提供最新的元分析,结合最近的证据.
主要方法:
- 随机临床试验和观察性研究的系统审查和元分析 (2006年1月 - 2025年6月).
- 包括有创伤性出血的成年人 (≥16岁),比较全血与组分疗法.
- 通过使用ROBINS-I和Cochrane RoB 2工具评估偏差风险.
- 采用随机效应的元分析与Hartung-Knapp调整.
主要成果:
- 分析了40项研究 (49,776名患者).
- 在平民创伤患者中,全血输血与24小时死亡率 (OR,0.76) 的降低有关.
- 在军事创伤患者中没有观察到显著的死亡益处 (OR,0.99).
- 平民也显示了30天死亡率和输血需求的降低.
结论:
- 全血输血与平民成年创伤患者的死亡率降低有关.
- 在军事环境中没有观察到好处,这表明特定于背景的有效性.
- 研究结果支持在民用中心选择性全血输血方案,并改进了患者选择标准.
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