Blood product use in trauma resuscitation: plasma deficit versus plasma ratio as predictors of mortality in trauma (CME).
Blood product use in trauma resuscitation: plasma deficit versus plasma ratio as predictors of mortality in trauma (CME).
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创伤复苏中的血液产物使用：血浆缺陷与血浆比例作为创伤死亡率（CME）的预测因子。
DOI：
10.1111/j.1537-2995.2010.03050.x
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发表时间：
2011-09
期刊：
影响因子：
2.9
通讯作者：
Hess JR
中科院分区：
文献类型：
--
作者：
de Biasi AR;Stansbury LG;Dutton RP;Stein DM;Scalea TM;Hess JR
以1：1的比例给予单位的浓缩红细胞（RBC）和血浆复苏快速出血的创伤患者与改善的结局相关。然而，受益的证明被幸存者偏见所混淆，我们小组过去的工作无法证明受益。我们确定了438例有大量输血风险的成人直接原发性创伤入院患者，他们在最初24小时内接受了≥5个RBC单位，生存概率为0.010至0.975。我们将存活率与按小时使用的RBC和血浆相关联，在整个组中以及在使用5-9和>9单位RBC的组中，两者都作为比率（血浆单位/RBC单位）和血浆缺乏（RBC单位-血浆单位）。复苏在第3小时结束时基本完成58.3%，在第6小时结束时基本完成77.9%。按小时计算的死亡率与复苏前2小时内血浆缺乏状态恶化显著相关（P<0.001和0.01），但与血浆比率无关。在TRISS评分为0.200-0.800的亚组中，早期血浆充盈与较少的血液制品使用相关，与损伤严重程度无关（P<0.001）。1)血浆补充的功效在复苏的最初几个小时内发挥; 2）血浆缺乏可能是某些人群中更敏感的功效标志物; 3）早期血浆补充似乎可以防止某些患者继续需要大量输血。
Resuscitation of rapidly bleeding trauma patients with units of packed red blood cells (RBCs) and plasma given in a 1:1 ratio has been associated with improved outcome. However, demonstration of a benefit is confounded by survivor bias, and past work from our group has been unable to demonstrate a benefit. We identified 438 adult direct primary trauma admissions at risk for massive transfusion who got ≥5 RBC units in the first 24 hours and had a probability of survival of 0.010 to 0.975. We correlated survival with RBC and plasma use by hour, both as a ratio (units of plasma/units of RBC) and a plasma deficit (units of RBC – units of plasma) in the group as a whole and among those using 5–9 and >9 units of RBC. Resuscitation was essentially complete in 58.3% by the end of the third hour and 77.9% by the end of the 6th hour. Mortality by hour was significantly associated with worse plasma deficit status in the first 2 hours of resuscitation (P<0.001 and 0.01) but not with plasma ratio. In a subgroup with TRISS 0.200–0.800, early plasma repletion was associated with less blood product use independently of injury severity (P<0.001). 1) The efficacy of plasma repletion plays out in the first few hours of resuscitation; 2) plasma deficit may be a more sensitive marker of efficacy in some populations; and 3) early plasma repletion appears to prevent some patients from going on to require massive transfusion.
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DOI：
10.1097/00005373-197611000-00006
发表时间：
1976-01-01
影响因子：
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作者：
BAKER, SP;ONEILL, B
通讯作者：
ONEILL, B
DOI：
10.1097/ta.0b013e3181878028
发表时间：
2008-11-01
影响因子：
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Moore, Ernest E.
DOI：
10.1097/ta.0b013e318196c3ac
发表时间：
2009-02-01
影响因子：
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作者：
Snyder, Christopher W.;Weinberg, Jordan A.;Kerby, Jeffrey D.
通讯作者：
Kerby, Jeffrey D.
DOI：
10.1097/ta.0b013e31817de3e1
发表时间：
2008-08-01
影响因子：
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作者：
Kashuk, Jeffry L.;Moore, Ernest E.;Sauaia, Angela
通讯作者：
Sauaia, Angela
DOI：
10.1097/ta.0b013e3181bbfe2a
发表时间：
2010-09-01
影响因子：
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作者：
Dutton, Richard P.;Stansbury, Lynn G.;Scalea, Thomas M.
通讯作者：
Scalea, Thomas M.