Blood product ratio in acute traumatic coagulopathy - effect on mortality in a Scandinavian level 1 trauma centre
Blood product ratio in acute traumatic coagulopathy - effect on mortality in a Scandinavian level 1 trauma centre
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DOI：
10.1186/1757-7241-18-65
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发表时间：
2010-12-07
影响因子：
3.3
通讯作者：
Johansson, Par I.
中科院分区：
文献类型：
--
作者：
Dirks, Jesper;Jorgensen, Henrik;Johansson, Par I.
背景：创伤是世界范围内预期寿命损失的主要原因。在受伤最严重的病人中，凝血功能障碍通常在入院时就存在。因此，已经引入了模拟全血的增加血浆（FFP）和血小板（PLT）与红细胞（RBC）的比率的输血策略。几项研究报告说，较高的比率提高了大出血患者的生存率。在这里，目的是探讨增加FFP和血小板红细胞对死亡率的潜在影响，在创伤patients.Methods：在回顾性研究之前和之后，所有创伤患者主要收治到一级创伤中心，接受输血，在2001-3（n = 97）和2005-7（n = 156），包括在内。在2001-3年，FFP和PLT按照美国麻醉医师协会（阿萨）指南进行给药，而在2005-7年，采用了止血控制复苏（HCR），即在不受控制的出血期间预先使用输血包中的FFP和PLT，然后在血栓弹力图（TEG）分析的指导下进行。结果：包括在早期和晚期的患者具有可比的人口统计学，损伤严重程度评分（ISS），入院血液学和凝血功能障碍（27%对34%的APTT高于正常）。输血实践发生了显着变化，从入院到首次输血的时间间隔更短（中位时间为3分钟，而大出血者为28分钟，p < 0.001），输血的FFP：RBC、PLT：RBC和PLT：FFP比例更高HCR组中，但两个时期的30天死亡率仍然相当。在2005年至2007年期间，较高的年龄，ISS和活化部分凝血活酶时间（APTT）高于正常的死亡率的独立预测因素，而没有关联是基金之间的血液制品比率和mortality.Conclusion：积极管理的FFP和PLT并没有影响死亡率在目前的创伤人口。
Background: Trauma is the leading cause of loss of life expectancy worldwide. In the most seriously injured patients, coagulopathy is often present on admission. Therefore, transfusion strategies to increase the ratio of plasma (FFP) and platelets (PLT) to red blood cells (RBC), simulating whole blood, have been introduced. Several studies report that higher ratios improve survival in massively bleeding patients. Here, the aim was to investigate the potential effect of increased FFP and PLT to RBC on mortality in trauma patients.Methods: In a retrospective before and after study, all trauma patients primarily admitted to a level-one Trauma Centre, receiving blood transfusion, in 2001-3 (n = 97) and 2005-7 (n = 156), were included. In 2001-3, FFP and PLT were administered in accordance with the American Society of Anesthesiologists (ASA) guidelines whereas in 2005-7, Hemostatic Control Resuscitation (HCR) entailing pre-emptive use of FFP and PLT in transfusion packages during uncontrolled haemorrhage and thereafter guided by thrombelastograph (TEG) analysis was employed. The effect of transfusion therapy and coagulopathy on mortality was investigated.Results: Patients included in the early and late period had comparable demography, injury severity score (ISS), admission hematology and coagulopathy (27% vs. 34% had APTT above normal). There was a significant change in blood transfusion practice with shorter time interval from admission to first transfusion (median time 3 min vs. 28 min in massive bleeders, p < 0.001), transfusion of higher ratios of FFP:RBC, PLT:RBC and PLT:FFP in the HCR group but 30-day mortality remained comparable in the two periods. In the 2005-7 period, higher age, ISS and Activated Partial Thromboplastin Time (APTT) above normal were independent predictors of mortality whereas no association was fund between blood product ratios and mortality.Conclusion: Aggressive administration of FFP and PLT did not influence mortality in the present trauma population.