Simmons John W, White Christopher E, Eastridge Brian J, Holcomb John B, Perkins Jeremy G, Mace James E, Blackbourne Lorne H
United States Army Institute of Surgical Research, Fort Sam Houston, Texas 78234, USA.
J Trauma. 2011 Jul;71(1 Suppl):S82-6. doi: 10.1097/TA.0b013e3182218ddb.
Studies have shown decreased mortality after improvements in combat casualty care, including increased fresh frozen plasma (FFP):red blood cell (RBC) ratios. The objective was to evaluate the evolution and impact of improved combat casualty care at different time periods of combat operations.
A retrospective review was performed at one combat support hospital in Iraq of patients requiring both massive transfusion (≥ 10 units RBC in 24 hours) and exploratory laparotomy. Patients were divided into two cohorts based on year wounded: C1 between December 2003 and June 2004, and C2 between September 2007 and May 2008. Admission data, amount of blood products and fluid transfused, and 48 hour mortality were compared. Statistical significance was set at p < 0.05.
There was decreased mortality in C2 (47% vs. 20%). Patients arrived warmer with higher hemoglobin. They were transfused more RBC and FFP in the emergency department (5 units ± 3 units vs. 2 units ± 2 units; 3 units ± 2 units vs. 0 units ± 1 units, respectively) and received less crystalloid in operating room (3.3 L ± 2.2 L vs. 8.5 L ± 4.9 L). The FFP:RBC ratio was also closer to 1:1 in C2 (0.775 ± 0.32 vs. 0.511 ± 0.21).
The combination of improved prehospital care, trauma systems approach, performance improvement projects, and improved transfusion or resuscitation practices have led to a 50% decrease in mortality for this critically injured population. We are now transfusing blood products in a ratio more consistent with 1 FFP to 1 RBC. Simultaneously, crystalloid use has decreased by 61%, all of which is consistent with hemostatic resuscitation principles.
研究表明，包括提高新鲜冰冻血浆（FFP）与红细胞（RBC）的比例在内，战斗伤员救治水平提高后死亡率有所下降。目的是评估在战斗行动不同时间段内，改进战斗伤员救治的演变及影响。
对伊拉克一家战斗支援医院中需要大量输血（24小时内≥10单位RBC）且接受剖腹探查术的患者进行回顾性研究。根据受伤年份将患者分为两组：C1组为2003年12月至2004年6月期间受伤的患者，C2组为2007年9月至2008年5月期间受伤的患者。比较两组患者的入院数据、输注的血液制品和液体量以及48小时死亡率。设定统计学显著性水平为p < 0.05。
C2组的死亡率有所下降（47%对20%）。C2组患者到达时体温更高，血红蛋白水平更高。他们在急诊科输注了更多的RBC和FFP（分别为5单位±3单位对2单位±2单位；3单位±2单位对0单位±1单位），在手术室接受的晶体液更少（3.3升±2.2升对8.5升±4.9升）。C2组的FFP:RBC比例也更接近1:1（0.775±0.32对0.511±0.21）。
院前护理改善、创伤系统方法、绩效改进项目以及输血或复苏实践的改进相结合，使得这群重伤患者的死亡率降低了50%。我们现在输注血液制品的比例更符合1单位FFP对1单位RBC。同时，晶体液的使用量减少了61%，所有这些都符合止血复苏原则。
