Department of Surgery, Wayne State University, Detroit, Michigan, USA.
J Trauma Acute Care Surg. 2012 Apr;72(4):821-7. doi: 10.1097/TA.0b013e3182484111.
Controversy exists about the ideal fresh frozen plasma/red blood cell (FFP/RBC) ratio for resuscitation of patients requiring massive transfusion (MT). This study correlates the FFP/RBC with clotting time (CT), prothrombin time (PT), partial thromboplastin time (PTT), and thrombin time (TT); with procoagulants (fibrinogen [FI], factor 5 [FV], and factor 8 [FVIII]); and with adult respiratory distress syndrome (pO2/FIO2).
The 32 patients studied in operating room (OR) were in shock for 47 minutes and received an average of 17.6 units RBC, 4.2 units FFP, and 14.2 L balanced electrolyte solution. The 53 patients (including 22 of the OR patients), studied an average of 9.5 hours after operation, had an average shock time of 42 minutes, and received 17.4 units RBC, 4.6 units FFP, and 12.3 L balanced electrolyte solution in OR.
The FFP/RBC in OR averaged 0.3:1 (range: 0.1:1 to 0.9:1). The OR study, done after a minimum of 10 RBC units at 3.8 hours, showed a PT of 3.5 seconds off normal (international normalized ratio < 1.3), a PTT of 34 seconds, and TT of 7.9 seconds off normal. FI, FV, and FVIII were restored to 148 mg/dL, 54%, and 81%. The pO2/FIO2 was 282. The early post-OR study showed a PT of 2.3 seconds off normal (international normalized ratio = 1.2), a PTT of 32 seconds, a TT of 7.2 seconds off normal, an FI of 207 mg/dL, an FV of 64%, an FVIII of 102%, and a pO2/FIO2 of 332. Both OR and early post-OR CTs and procoagulant levels are associated with adequate coagulation. All patients with a 0.31:1 or higher FFP/RBC had sufficient restoration of CTs and procoagulants.
These data show that an FFP/RBC ratio above 0.31:1 in injured patients requiring MT restores CTs and procoagulant to clinically effective levels while not causing adult respiratory distress syndrome. Future studies on defining the ideal FFP/RBC ratio for MT should monitor CTs, procoagulants, and organ function.
关于需要大量输血（MT）的患者复苏时理想的新鲜冷冻血浆/红细胞（FFP/RBC）比例存在争议。本研究将 FFP/RBC 与凝血时间（CT）、凝血酶原时间（PT）、部分凝血活酶时间（PTT）和凝血时间（TT）相关联；与促凝血剂（纤维蛋白原[FI]、因子 5 [FV]和因子 8 [FVIII]）相关联；与成人呼吸窘迫综合征（pO2/FIO2）相关联。
在手术室（OR）中接受研究的 32 名患者休克 47 分钟，平均接受 17.6 单位 RBC、4.2 单位 FFP 和 14.2L 平衡电解质溶液。在平均 9.5 小时后接受手术的 53 名患者（包括 22 名 OR 患者），平均休克时间为 42 分钟，在 OR 中接受了 17.4 单位 RBC、4.6 单位 FFP 和 12.3L 平衡电解质溶液。
OR 中的 FFP/RBC 平均为 0.3:1（范围：0.1:1 至 0.9:1）。在至少接受 10 单位 RBC 后的 3.8 小时进行的 OR 研究显示 PT 正常时间为 3.5 秒（国际标准化比值<1.3），PTT 为 34 秒，TT 正常时间为 7.9 秒。FI、FV 和 FVIII 恢复至 148mg/dL、54%和 81%。pO2/FIO2 为 282。OR 后的早期研究显示 PT 正常时间为 2.3 秒（国际标准化比值=1.2），PTT 为 32 秒，TT 正常时间为 7.2 秒，FI 为 207mg/dL，FV 为 64%，FVIII 为 102%，pO2/FIO2 为 332。OR 和早期 OR 的 CT 和促凝血因子水平均与凝血功能正常相关。所有 FFP/RBC 比值为 0.31:1 或更高的患者的 CT 和促凝血因子均得到充分恢复。
这些数据表明，在需要大量输血的受伤患者中，FFP/RBC 比值高于 0.31:1 可将 CT 和促凝血因子恢复到临床有效水平，而不会引起成人呼吸窘迫综合征。关于大量输血中理想 FFP/RBC 比例的未来研究应监测 CT、促凝血因子和器官功能。
