Department of Anesthesia, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA
Transfusion. 2011 Sep;51(9):1925-32. doi: 10.1111/j.1537-2995.2010.03050.x. Epub 2011 Feb 18.
Resuscitation of rapidly bleeding trauma patients with units of red blood cells (RBCs) and plasma given in a 1:1 ratio has been associated with improved outcome. However, demonstration of a benefit is confounded by survivor bias, and past work from our group has been unable to demonstrate a benefit.
We identified 438 adult direct primary trauma admissions at risk for massive transfusion who received 5 or more RBC units in the first 24 hours and had a probability of survival of 0.010 to 0.975. We correlated survival with RBC and plasma use by hour, both as a ratio (units of plasma/units of RBC) and as a plasma deficit (units of RBC - units of plasma) in the group as a whole and among those using 5 to 9 and more than 9 units of RBCs.
Resuscitation was essentially complete in 58.3% by the end of the third hour and 77.9% by the end of the sixth hour. Mortality by hour was significantly associated with worse plasma deficit status in the first 2 hours of resuscitation (p < 0.001 and p < 0.01) but not with plasma ratio. In a subgroup with a Trauma Revised Injury Severity Score of 0.200 to 0.800, early plasma repletion was associated with less blood product use independently of injury severity (p < 0.001).
以 1:1 的比例输注红细胞（RBC）和血浆单位对快速出血创伤患者进行复苏与改善结果相关。然而，幸存者偏差使证明获益变得复杂，并且我们小组过去的工作未能证明获益。
我们确定了 438 名成人直接原发性创伤入院患者，他们在最初 24 小时内接受了 5 个或更多 RBC 单位的治疗，并且存活概率为 0.010 至 0.975。我们将存活与 RBC 和血浆的使用相关联，既可以通过小时来比较（单位血浆/单位 RBC），也可以将整个组中以及使用 5 到 9 个和 9 个以上 RBC 单位的患者中的血浆缺乏量（单位 RBC-单位血浆）作为一个比值来比较。
在第三小时结束时，复苏基本上完成了 58.3%，在第六小时结束时完成了 77.9%。在复苏的前 2 小时内，死亡率与更差的血浆缺乏状态显著相关（p < 0.001 和 p < 0.01），但与血浆比例无关。在创伤修订损伤严重程度评分在 0.200 至 0.800 之间的亚组中，早期补充血浆与受伤严重程度无关，独立地与更少的血液制品使用相关（p < 0.001）。
1）血浆补充的疗效在复苏的前几个小时内显现，2）血浆缺乏可能是某些人群中更敏感的疗效标志物，3）早期补充血浆似乎可以防止一些患者继续需要大量输血。
