Malone Debra L, Hess John R, Fingerhut Abe
Department of Surgery, University of Maryland Medical Center, Baltimore, USA.
J Trauma. 2006 Jun;60(6 Suppl):S91-6. doi: 10.1097/01.ta.0000199549.80731.e6.
Massive transfusion, the administration of 10 to more than 100 units of red blood cells (RBC) in less than 24 hours, can be a life saving therapy in the treatment of severe injury. The rapid administration of large numbers of RBC, along with sufficient plasma and platelets to treat or prevent coagulopathy, is frequently a disorderly process. Patient care and collaborative research might be aided with a common protocol.
The authors polled trauma organizations and trauma centers to find examples of massive transfusion protocols. The goals and ease of use of these protocols were evaluated.
Massive transfusion protocols exist at a relatively small number of large and well-organized trauma centers. Most of these protocols are designed to treat pre-existing and/or ongoing coagulopathy.
The evidence would suggest that prevention of coagulopathy is superior to its treatment. Simple ratios such as 1:1:1 RBC:plasma:platelets have the benefit of ease of use and the relatively higher plasma and platelet doses appear to be associated with improved outcome. Such a standard protocol can foster multicenter research on resuscitation and hemorrhage control. The fixed volume ratios might allow the number and rate of administered units of RBC to be used as surrogates for blood loss and primary treatment effect.
大量输血是指在不到24小时内输注10至100多个单位的红细胞（RBC），在治疗严重创伤时是一种挽救生命的疗法。快速输注大量红细胞，同时输注足够的血浆和血小板以治疗或预防凝血功能障碍，这一过程往往杂乱无章。通用方案可能有助于患者护理和协作研究。
作者对创伤组织和创伤中心进行了调查，以寻找大量输血方案的实例。对这些方案的目标和易用性进行了评估。
相对较少的大型且组织良好的创伤中心存在大量输血方案。这些方案大多旨在治疗已存在的和/或正在发生的凝血功能障碍。
有证据表明，预防凝血功能障碍优于治疗凝血功能障碍。简单的比例，如1:1:1的红细胞:血浆:血小板，具有易用性的优点，相对较高的血浆和血小板剂量似乎与改善预后相关。这样一个标准方案可以促进关于复苏和出血控制的多中心研究。固定的体积比可能使输注的红细胞单位数量和速率用作失血和主要治疗效果的替代指标。
