Division of Vascular Surgery, Stanford University, Stanford, CA, USA.
Surgery. 2010 Nov;148(5):955-62. doi: 10.1016/j.surg.2010.02.002. Epub 2010 Apr 7.
The ratio of red blood cell (PRBC) transfusion to plasma (FFP) transfusion (PRBC:FFP ratio) has been shown to impact survival in trauma patients with massive hemorrhage. The purpose of this study was to determine the effect of the PRBC:FFP ratio on mortality for patients with massive hemorrhage after ruptured abdominal aortic aneurysm (RAAA).
A retrospective review was performed of patients undergoing emergent open RAAA repair from January 1987 to December 2007. Patients with massive hemorrhage (≥10 units of blood products transfused prior to conclusion of the operation) were included. The effects of patient demographics, admission vital signs, laboratory values, peri-operative variables, amount of blood products transfused, and the PRBC:FFP ratio on 30-day mortality were analyzed by multivariate analysis.
One hundred and twenty-eight of the 168 (76%) patients undergoing repair for RAAA received at least 10 units of blood products within the peri-operative period. Mean age was 73.1 ± 9.1 years, and 109 (85%) were men. Thirty-day mortality was 22.6% (29/128), including 11 intra-operative deaths. By multivariate analysis, 30-day mortality was markedly lower (15% vs 39%; P < .03) for patients transfused at a PRBC:FFP ratio ≤2:1 (HIGH FFP group) compared with those transfused at a ratio of >2:1 (LOW FFP), and the likelihood of death was more than 4-fold greater in the LOW FFP group (odds ratio 4.23; 95% confidence interval, 1.2-14.49). Patients in the HIGH FFP group had a significantly lower incidence of colon ischemia than those in the LOW FFP group (22.4% vs 41.1%; P = .004).
For RAAA patients requiring massive transfusion, more equivalent transfusion of PRBC to FFP (HIGH FFP) was independently associated with lower 30-day mortality. The lower incidence of colonic ischemia in the HIGH FFP group may suggest an additional benefit of early plasma transfusion that could translate into further mortality reduction. Analysis from this study suggests the potential feasibility for a more standardized protocol of initial resuscitation for these patients, and prospective studies are warranted to determine the optimum PRBC:FFP ratio in RAAA patients.
已有研究表明，红细胞（PRBC）与血浆（FFP）的输注比例（PRBC：FFP 比值）会影响创伤性大量出血患者的生存率。本研究旨在确定 PRBC：FFP 比值对破裂性腹主动脉瘤（RAAA）后大量出血患者死亡率的影响。
对 1987 年 1 月至 2007 年 12 月期间接受急诊开放 RAAA 修复的患者进行回顾性分析。纳入大量出血（手术结束前输注≥10 单位血液制品）的患者。采用多变量分析，分析患者人口统计学、入院生命体征、实验室值、围手术期变量、输注的血液制品量以及 PRBC：FFP 比值对 30 天死亡率的影响。
168 例接受 RAAA 修复的患者中，128 例（76%）在围手术期内至少输注了 10 个单位的血液制品。平均年龄为 73.1±9.1 岁，109 例（85%）为男性。30 天死亡率为 22.6%（29/128），其中 11 例为术中死亡。多变量分析显示，PRBC：FFP 比值≤2：1（高 FFP 组）的患者 30 天死亡率明显低于比值>2：1（低 FFP 组）（15%比 39%；P<.03），低 FFP 组患者死亡的可能性是高 FFP 组的 4 倍以上（比值比 4.23；95%置信区间，1.2-14.49）。高 FFP 组患者结肠缺血的发生率明显低于低 FFP 组（22.4%比 41.1%；P=.004）。
对于需要大量输血的 RAAA 患者，PRBC 与 FFP 更均等的输注（高 FFP）与较低的 30 天死亡率独立相关。高 FFP 组结肠缺血发生率较低，这可能表明早期输血有额外益处，可进一步降低死亡率。本研究的分析表明，这些患者初始复苏的标准化方案具有潜在的可行性，有必要进行前瞻性研究以确定 RAAA 患者的最佳 PRBC：FFP 比值。
