Transfusion Medicine and Cellular Therapy, Department of Pathology and Laboratory, Medicine, Weill Cornell Medical College, New York, New York, USA.
Minerva Anestesiol. 2011 Mar;77(3):349-59.
Massive transfusion is an essential part of resuscitation efforts in acute trauma patients. The goal is to quickly correct trauma-induced coagulopathy and replace red blood cell (RBC) mass with the minimal number as well as the appropriate choice of blood components to minimize the possible adverse effects of transfusions. Early trauma induced coagulopathy (ETIC) is present in about 20% of patients upon hospital admission and predicts for decreased survival. The mechanism of ETIC is still being elucidated; however, most theories of ETIC's pathophysiology justify the early use of plasma. Most massive transfusion protocol (MTP) ratios deliver blood products in a ratio of 1:1:1 for RBCs:plasma:platelets, which is supported by the majority of the literature demonstrating improved patient survival with higher ratios (>1 plasma and platelet for every 2 RBCs transfused). Indeed, formula-driven MTPs allow trauma services to react quickly to ETIC and provide coagulation factors and platelets in these ratios without having to wait for the results of coagulation assays while the patient's coagulopathy worsens. New MTPs are being created which are adjusted according to an individual's coagulation laboratory values based on point-of-care laboratory tests, such as thromboelastography. When creating an MTP, product wastage due to inappropriate activation and improper product storage should be considered and closely monitored. Another area of discussion regarding transfusion in trauma includes the potential association of prolonged storage of RBCs and adverse outcomes, which has yet to be confirmed. Significant progress has been made in the transfusion management of trauma patients, but further studies are required to optimize patient care and outcomes.
大量输血是急性创伤患者复苏努力的重要组成部分。其目的是快速纠正创伤引起的凝血功能障碍，并以最少的数量和适当的血液成分替代红细胞（RBC），以最大限度地减少输血的可能不良反应。早期创伤诱导的凝血功能障碍（ETIC）在入院时约有 20%的患者存在，并预测生存率降低。ETIC 的机制仍在阐明中；然而，ETIC 的大多数病理生理学理论都证明了早期使用血浆的合理性。大多数大量输血方案（MTP）以 1:1:1 的比例输送 RBC：血浆：血小板，这得到了大多数文献的支持，这些文献表明更高的比例（每 2 个 RBC 输注就有超过 1 个血浆和血小板）可提高患者的生存率。事实上，配方驱动的 MTP 允许创伤服务部门迅速对 ETIC 做出反应，并在患者凝血功能恶化的情况下，无需等待凝血检测结果，就可以按这些比例提供凝血因子和血小板。新的 MTP 根据个体的凝血实验室值进行调整，基于即时检测实验室测试，如血栓弹力图。在创建 MTP 时，应考虑并密切监测由于不当激活和不当产品储存而导致的产品浪费。关于创伤输血的另一个讨论领域包括 RBC 储存时间延长与不良结局之间的潜在关联，这一点尚未得到证实。创伤患者的输血管理已经取得了重大进展，但仍需要进一步的研究来优化患者的护理和结局。
