Moore Frederick A, Nelson Teresa, McKinley Bruce A, Moore Ernest E, Nathens Avery B, Rhee Peter, Puyana Juan Carlos, Beilman Gregory J, Cohn Stephen M
Department of Surgery, The Methodist Hospital, Houston, TX, USA.
Am J Surg. 2008 Dec;196(6):948-58; discussion 958-60. doi: 10.1016/j.amjsurg.2008.07.043.
Damage control resuscitation (DCR) with early plasma in combat casualties requiring massive transfusion (MT) decreases early deaths from bleeding.
To ascertain the potential role of early plasma DCR in civilian MT, we queried a prospective traumatic shock database of 383 civilians.
Ninety-three (24%) of the traumatic shock civilians received a MT, of which 26 (28%) died early, predominantly from bleeding within 6 hours. Comparatively, this early MT death cohort arrived in more severe shock and were coagulopathic (mean INR 2.4). In the critical period of MT (ie, the first 3 hours), these patients received 20 U of packed red blood cells (PRBCs) but only 4 U of fresh frozen plasma (FFP). They remained severely acidotic and their coagulopathy worsened as they exsanquinated.
Civilians who arrived in traumatic shock, required a MT, and died early had worsening coagulopathy, which was not treated. DCR with FFP may have a role in civilian trauma.
对于需要大量输血（MT）的战斗伤员，早期输注血浆进行损伤控制复苏（DCR）可降低出血导致的早期死亡。
为确定早期血浆DCR在 civilian MT 中的潜在作用，我们查询了一个包含383名 civilian 的前瞻性创伤性休克数据库。
93名（24%）创伤性休克 civilian 接受了 MT，其中26名（28%）早期死亡，主要死于6小时内的出血。相比之下，这个早期MT死亡队列入院时休克更严重且存在凝血功能障碍（平均国际标准化比值2.4）。在MT的关键时期（即最初3小时），这些患者输注了20单位浓缩红细胞（PRBCs），但仅输注了4单位新鲜冰冻血浆（FFP）。随着他们失血，仍处于严重酸中毒状态且凝血功能障碍恶化。
因创伤性休克入院、需要MT且早期死亡的 civilian 存在未得到治疗的凝血功能障碍恶化情况。FFP进行DCR可能在 civilian 创伤中发挥作用。
