Damage control resuscitation is associated with a reduction in resuscitation volumes and improvement in survival in 390 damage control laparotomy patients.
Damage control resuscitation is associated with a reduction in resuscitation volumes and improvement in survival in 390 damage control laparotomy patients.
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DOI：
10.1097/sla.0b013e318230089e
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发表时间：
2011-10
影响因子：
9
通讯作者：
Holcomb JB
中科院分区：
文献类型：
--
作者：
Cotton BA;Reddy N;Hatch QM;LeFebvre E;Wade CE;Kozar RA;Gill BS;Albarado R;McNutt MK;Holcomb JB
确定在接受损伤控制剖腹手术 (DCL) 的患者中实施损伤控制复苏 (DCR) 是否可以提高生存率。 DCR 旨在通过允许性低血压、限制晶体和提供更高比例的血浆和血小板来预防凝血障碍。以前的工作仅关注提供更高比率（1:1:1）的影响。对 2004 年 1 月至 2010 年 8 月期间收治的所有 DCL 患者进行了回顾性队列研究。患者被分为 DCR 实施前组和 DCR 组，如果在初始剖腹手术完成之前死亡则被排除在外。致死三联征被定义为术后立即温度<95°F、INR>1.5或pH<7.30。 390 名患者接受了 DCL。其中，282 例为 DCR 前，108 例为 DCR。各组在人口统计学、损伤严重程度、入院生命体征和实验室值方面相似。 DCR患者在24小时内接受较少的晶体液（中位14 L vs. 5 L）、红细胞（13 U vs. 7 U）、血浆（11 U vs. 8 U）和血小板（6 U vs. 0 U）；所有 p<0.05。 DCR 患者到达 ICU 后，致命三联征的证据较少（80% vs. 46%，p<0.001）。 DCR 的 24 小时和 30 天生存率更高（88% vs. 97%，p=0.006；76% vs. 86%，p=0.03）。控制年龄、损伤严重程度和 ED 变量的多变量分析表明，DCR 与 30 天生存率显着增加相关（O.R. 2.5，95% C.I. 1.10-5.58，p=0.028）。在接受 DCL 的患者中，实施 DCR 可以减少晶体和血液制品的使用。更重要的是，DCR 与 30 天生存率的改善相关。
To determine if implementation of damage control resuscitation (DCR) in patients undergoing damage control laparotomy (DCL) translates into improved survival. DCR aims at preventing coagulopathy through permissive hypotension, limiting crystalloids and delivering higher ratios of plasma and platelets. Previous work has focused only on the impact of delivering higher ratios (1:1:1). A retrospective cohort study was performed on all DCL patients admitted between 01/2004–08/2010. Patients were divided into pre-DCR implementation and DCR groups, and were excluded if they died prior to completion of the initial laparotomy. The lethal triad was defined as immediate post-operative temperature <95° F, INR>1.5, or a pH<7.30. 390 patients underwent DCL. Of these, 282 were pre-DCR and 108 were DCR. Groups were similar in demographics, injury severity, admission vitals and laboratory values. DCR patients received less crystalloids (median 14 L vs. 5 L), RBC (13 U vs. 7 U), plasma (11 U vs. 8 U) and platelets (6 U vs. 0 U) in 24-hr; all p<0.05. DCR patients had less evidence of the lethal triad upon ICU arrival (80% vs. 46%, p<0.001). 24-hour and 30-day survival were higher with DCR (88% vs. 97%, p=0.006 and 76% vs. 86%, p=0.03). Multivariate analysis controlling for age, injury severity, and ED variables, demonstrated DCR was associated with a significant increase in 30-day survival (O.R. 2.5, 95% C.I. 1.10–5.58, p=0.028). In patients undergoing DCL, implementation of DCR reduces crystalloid and blood product administration. More importantly, DCR is associated with an improvement in 30-day survival.