Morse Bryan C, Dente Christopher J, Hodgman Erica I, Shaz Beth H, Winkler Anne, Nicholas Jeffrey M, Wyrzykowski Amy D, Rozycki Grace S, Feliciano David V
Department of Surgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, Georgia, USA.
Am Surg. 2012 Jun;78(6):679-84.
There are little data regarding the use of massive transfusion protocols (MTP) outside of the trauma setting. This study compares the use of an MTP between trauma and non-trauma (NT) patients. Data were collected for trauma and NT patients from the prospectively maintained MTP database at a Level I trauma center over a 4-year period. Massive transfusion was defined as ≥ 10 units packed red blood cells (PRBCs) in a 24-hour period. Of 439 MTP activations, 37 (8%) were NT patients (64% male; mean age = 51 years, initial base deficit = -10.8). Activations were for gastrointestinal bleeding (n = 18), bleeding during surgery (n = 13), obstetrical complications (n = 5), and ruptured aortic aneurysm (n = 1). Over-activation of MTP (<10 units PRBCs/24 hours) was higher in NT than trauma patients (19/37, 51% vs 118/284, 29%, P < 0.01). For massive transfusion patients, 24-hour mortality was higher in NT compared with trauma patients (10/17, 59% vs 100/284, 35%, P = 0.05), but there was no difference in 30-day mortality (10/17, 59% vs 144/284, 51%, P = 0.51). With over-activation in 51% of NT patients, MTP usage outside of trauma is inefficient. Outcomes in NT patients were worse than trauma patients, which may be related to the underlying disease processes.
关于在创伤环境之外使用大量输血方案（MTP）的数据很少。本研究比较了创伤患者和非创伤（NT）患者对MTP的使用情况。在4年期间，从一级创伤中心前瞻性维护的MTP数据库中收集了创伤患者和NT患者的数据。大量输血定义为在24小时内输注≥10单位浓缩红细胞（PRBC）。在439次MTP激活中，37例（8%）为NT患者（64%为男性；平均年龄=51岁，初始碱缺失=-10.8）。激活原因包括胃肠道出血（n=18）、手术中出血（n=13）、产科并发症（n=5）和主动脉瘤破裂（n=1）。NT患者中MTP过度激活（<10单位PRBC/24小时）的比例高于创伤患者（19/37，51%对118/284，29%，P<0.01）。对于大量输血患者，NT患者的24小时死亡率高于创伤患者（10/17，59%对100/284，35%，P=0.05），但30天死亡率无差异（10/17，59%对144/284，51%，P=0.51）。由于51%的NT患者存在过度激活，创伤环境之外的MTP使用效率低下。NT患者的结局比创伤患者更差，这可能与潜在的疾病过程有关。
