Snyder Christopher W, Weinberg Jordan A, McGwin Gerald, Melton Sherry M, George Richard L, Reiff Donald A, Cross James M, Hubbard-Brown Jennifer, Rue Loring W, Kerby Jeffrey D
Section of Trauma, Burns, and Surgical Critical Care, Department of Surgery, University of Alabama-Birmingham, Birmingham, Alabama 35294, USA.
J Trauma. 2009 Feb;66(2):358-62; discussion 362-4. doi: 10.1097/TA.0b013e318196c3ac.
Recent studies show an apparent survival advantage associated with the administration of higher cumulative ratios of fresh frozen plasma (FFP) to packed red blood cells (PRBC). It remains unclear how temporal factors and survival bias may influence these results. The objective of this study was to evaluate the temporal relationship between blood product ratios and mortality in massively transfused trauma patients.
Patients requiring massive transfusion (>10 units of PRBC within 24 hours of admission) between 2005 and 2007 were identified (n = 134). In-hospital mortality was compared between patients receiving high (>1:2) versus low (<1:2) FFP:PRBC ratios with a regression model, using the FFP:PRBC ratio as a fixed value at 24 hours (method I) and as a time-varying covariate (method II).
The FFP:PRBC ratio for all patients was low early and increased over time. Sixty-eight percent of total blood products were given and 54% of deaths occurred during the first 6 hours. Using method I, patients receiving a high FFP:PRBC ratio (mean, 1:1.3) by 24 hours had a 63% lower risk of death (RR, 0.37; 95% CI, 0.22-0.64) compared with those receiving a low ratio (mean, 1:3.7). However, this association was no longer statistically significant (RR, 0.84; 95% CI, 0.47-1.50) when the timing of component product transfusion was taken into account (method II).
Similar to previous studies, an association between higher FFP:PRBC ratios at 24 hours and improved survival was observed. However, after adjustment for survival bias in the analysis, the association was no longer statistically significant. Prospective trials are necessary to evaluate whether hemostatic resuscitation is clinically beneficial.
近期研究表明，给予较高累积比例的新鲜冰冻血浆（FFP）与红细胞悬液（PRBC）具有明显的生存优势。目前尚不清楚时间因素和生存偏倚如何影响这些结果。本研究的目的是评估大量输血创伤患者血液制品比例与死亡率之间的时间关系。
确定2005年至2007年间需要大量输血（入院后24小时内输注>10单位PRBC）的患者（n = 134）。使用回归模型比较接受高（>1:2）与低（<1:2）FFP:PRBC比例的患者的院内死亡率，将FFP:PRBC比例作为24小时的固定值（方法I）和作为随时间变化的协变量（方法II）。
所有患者的FFP:PRBC比例早期较低，且随时间增加。68%的全血制品在最初6小时内输注，54%的死亡发生在这期间。使用方法I，到24小时时接受高FFP:PRBC比例（平均1:1.3）的患者与接受低比例（平均1:3.7）的患者相比，死亡风险降低63%（RR，0.37；95%CI，0.22 - 0.64）。然而，当考虑成分血输注时间时（方法II），这种关联不再具有统计学意义（RR，0.84；95%CI，0.47 - 1.50）。
与先前研究相似，观察到24小时时较高的FFP:PRBC比例与生存改善之间存在关联。然而，在分析中调整生存偏倚后，这种关联不再具有统计学意义。需要进行前瞻性试验来评估止血复苏是否具有临床益处。
