Postinjury life threatening coagulopathy:: Is 1:1 fresh frozen plasma:: Packed red blood cells the answer?
Postinjury life threatening coagulopathy:: Is 1:1 fresh frozen plasma:: Packed red blood cells the answer?
复制标题
DOI：
10.1097/ta.0b013e31817de3e1
复制
发表时间：
2008-08-01
影响因子：
--
通讯作者：
Sauaia, Angela
中科院分区：
文献类型：
--
作者：
Kashuk, Jeffry L.;Moore, Ernest E.;Sauaia, Angela
背景：最近的军事经验表明，对于需要每24小时采集10单位红细胞(RBC)的伤员，立即1：1新鲜冰冻血浆(FFP)；红细胞(RBC)可以降低死亡率，但目前还没有临床试验来解决这一问题。因此，我们回顾了我们5年来的大量输血实践，以检验1：1 FFP：RBC在前6小时内减少危及生命的凝血疾病的假设。方法：我们查询了2001-2006年间I级创伤中心接受大量输血的患者的预期登记。对133例在6小时内接受10单位RBC的患者进行Logistic回归分析，以评估FFP：RBC对(1)凝血障碍(6小时国际标准化比率[INR]>；1.5)的独立影响，并控制我们先前描述的预测凝血障碍的危险因素，以及RBC、FFP和血小板给药(2)死亡(控制所有变量加年龄，每24小时晶体含量，INR>；6小时1.5)。结果：总死亡率为56%；50%死于手术室急性失血。超过80%的RBC输注在前6小时内完成：(中位数：18单位)FFP中位数：RBC存活者：1：2，死亡：1：4。(P<；0.001)6小时内输注1.5者30例(23%)，死亡81%。在死亡率方面，Logistic回归分析显示有意义的变量有：每6小时红细胞计数(OR=1.248，95%CI：1.957~53.255)、6小时INR1.5(OR=10.208，95%CI：1.957~53.255)、ED温度34℃(OR=15.491，95%CI 1~376~174.396)、年龄55岁(OR=40.531，CI 5.315~53.255)。包括二次项的FFP/RBC比率的调整后的OR被发现遵循U型关联(二次项估计为0.6737+/-0.0345，P=0.0189)。结论：尽管我们的数据表明1：1的FFP：RBC减少了凝血障碍，但这并不能转化为生存的好处。我们的研究结果表明，凝血障碍和死亡率之间的关系更为复杂，在推荐常规1：1用于失血创伤患者之前，有必要进行进一步的临床研究。
Background: Recent military experience suggests that immediate 1:1 fresh frozen plasma (FFP); red blood cells (RBC) for casualties requiring >10 units packed red blood cells (RBC) per 24 hours reduces mortality, but no clinical trials exist to address this issue. Consequently, we reviewed our massive transfusion practices during a 5-year period to test the hypothesis that 1:1 FFP:RBC within the first 6 hours reduces life threatening coagulopathy.Methods: We queried our level I trauma center's prospective registry from 2001 to 2006 for patients undergoing massive transfusion. Logistic regression was used to evaluate the independent effect of FFP:RBC in 133 patients who received > 10 units RBC in 6 hours on (1) Coagulopathy (international normalized ratio [INR] > 1.5 at 6 hours), controlling for our previously described risk factors predictive of coagulopathy, as well as RBC, FFP, and platelet administration (2) Death (controlling for all variables plus age, crystalloids per 24 hours, INR > 1.5 at 6 hours).Results: Overall mortality was 56%; 50% died from acute blood loss in the operating room. Over 80% of the RBC transfusions were completed in the first 6 hours: (Median RBC: 18 units) Median FFP:RBC survivors, 1:2, nonsurvivors: 1:4. (p < 0.001) INR >1.5 at 6 hours occurred in 30 (23%); 81 % died. Regarding mortality, logistic regression showed significant variables (p < 0.05) included: RBC per 6 hours (OR = 1.248,95%CI: 1.957-53.255), INR at 6 hours > 1.5 (OR = 10.208, 95% CI: 1.957-53.255), ED temperature < 34 degrees C (OR = 15.491, 95 % CI 1-376-174.396), and age >55 years (OR = 40.531, CI 5.315-309.077). The adjusted OR for FFP:RBC ratio including the quadratic term was found to follow a U-shaped association (quadratic term estimate 0.6737 +/- 0.0345, P = 0.0189).Conclusion: Although our data suggest that 1:1 FFP:RBC reduced coagulopathy, this did not translate into a survival benefit. Our findings indicate that the relationship between coagulopathy and mortality is more complex, and further clinical investigation is necessary before recommending routine 1:1 in the exsanguinating trauma patient.