Sperry Jason L, Ochoa Juan B, Gunn Scott R, Alarcon Louis H, Minei Joseph P, Cuschieri Joseph, Rosengart Matthew R, Maier Ronald V, Billiar Timothy R, Peitzman Andrew B, Moore Ernest E
Division of General Surgery and Trauma, Departments of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
J Trauma. 2008 Nov;65(5):986-93. doi: 10.1097/TA.0b013e3181878028.
The detrimental effects of coagulopathy, hypothermia, and acidosis are well described as markers for mortality after traumatic hemorrhage. Recent military experience suggests that a high fresh frozen plasma (FFP):packed red blood cell (PRBC) transfusion ratio improves outcome; however, the appropriate ratio these transfusion products should be given remains to be established in a civilian trauma population.
Data were obtained from a multicenter prospective cohort study evaluating clinical outcomes in blunt injured adults with hemorrhagic shock. Those patients who required >/=8 units PRBCs within the first 12 hours postinjury were analyzed (n = 415).
Patients who received transfusion products in >/=1:1.50 FFP:PRBC ratio (high F:P ratio, n = 102) versus <1:1.50 FFP:PRBC ratio (low F:P, n = 313) required significantly less blood transfusion at 24 hours (16 +/- 9 units vs. 22 +/- 17 units, p = 0.001). Crude mortality differences between the groups did not reach statistical significance (high F:P 28% vs. low F:P 35%, p = 0.202); however, there was a significant difference in early (24 hour) mortality (high F:P 3.9% vs. low F:P 12.8%, p = 0.012). Cox proportional hazard regression revealed that receiving a high F:P ratio was independently associated with 52% lower risk of mortality after adjusting for important confounders (HR 0.48, p = 0.002, 95% CI 0.3-0.8). A high F:P ratio was not associated with a higher risk of organ failure or nosocomial infection, however, was associated with almost a twofold higher risk of acute respiratory distress syndrome, after controlling for important confounders.
In patients requiring >/=8 units of blood after serious blunt injury, an FFP:PRBC transfusion ratio >/=1:1.5 was associated with a significant lower risk of mortality but a higher risk of acute respiratory distress syndrome. The mortality risk reduction was most relevant to mortality within the first 48 hours from the time of injury. These results suggest that the mortality risk associated with an FFP:PRBC ratio <1:1.5 may occur early, possibly secondary to ongoing coagulopathy and hemorrhage. This analysis provides further justification for the prospective trial investigation into the optimal FFP:PRBC ratio required in massive transfusion practice.
凝血功能障碍、体温过低和酸中毒的有害影响作为创伤性出血后死亡率的标志物已得到充分描述。近期军事经验表明，高新鲜冰冻血浆（FFP）与红细胞悬液（PRBC）输注比例可改善预后；然而，在 civilian 创伤人群中，这些输血产品的合适输注比例仍有待确定。
数据来自一项多中心前瞻性队列研究，该研究评估钝性损伤并伴有失血性休克的成年患者的临床结局。分析那些在受伤后12小时内需要≥8单位 PRBC 的患者（n = 415）。
接受 FFP 与 PRBC 输注比例≥1:1.50（高 F:P 比例，n = 102）的患者与接受比例<1:1.50（低 F:P 比例，n = 313）的患者相比，在24小时时所需的输血量显著更少（16±9单位 vs. 22±17单位，p = 0.001）。两组之间的粗死亡率差异未达到统计学意义（高 F:P 比例组为28%，低 F:P 比例组为35%，p = 0.202）；然而，早期（24小时）死亡率存在显著差异（高 F:P 比例组为3.9%，低 F:P 比例组为12.8%，p = 0.012）。Cox 比例风险回归显示，在调整重要混杂因素后，接受高 F:P 比例与死亡风险降低52%独立相关（风险比0.48，p = 0.002，95%置信区间0.3 - 0.8）。高 F:P 比例与器官衰竭或医院感染风险升高无关，然而，在控制重要混杂因素后，与急性呼吸窘迫综合征风险升高近两倍相关。
在严重钝性损伤后需要≥8单位血液的患者中，FFP 与 PRBC 输注比例≥1:1.5 与显著降低的死亡风险相关，但与急性呼吸窘迫综合征风险升高相关。死亡风险降低与受伤后最初48小时内的死亡率最为相关。这些结果表明，FFP 与 PRBC 比例<1:1.5 相关的死亡风险可能早期就会出现，可能继发于持续的凝血功能障碍和出血。该分析为在大量输血实践中对最佳 FFP 与 PRBC 比例进行前瞻性试验研究提供了进一步的依据。
