Neal Matthew D, Marsh Alyce, Marino Ryan, Kautza Benjamin, Raval Jay S, Forsythe Raquel M, Marshall Gary T, Sperry Jason L
Division of General Surgery and Trauma, Department of Surgery, University of Pittsburgh Medical Center, 200 Lothrop St, F675 Watson Surgical Education Center, Presbyterian University Hospital, Pittsburgh, PA 15213, USA.
Arch Surg. 2012 Jun;147(6):563-71. doi: 10.1001/archsurg.2011.2212.
The design and implementation of massive transfusion protocols with ratio-based transfusion of blood and blood products are important and active areas of investigation. A significant yet controversial body of literature exists to support the use of hemostatic resuscitation in massive transfusion and new data to support the use of adjuncts, such as recombinant factor VIIa and tranexamic acid. We review the developments in massive transfusion research during the past 5 years, including protocol implementation, hemostatic resuscitation, the use of tranexamic acid, and goal-directed therapy for coagulopathy. Furthermore, we provide a level of evidence analysis of the data surrounding the use of component therapy and recombinant factor VIIa in massive transfusion, summary recommendations for the various agents of resuscitation, and new methods of goal-directed therapy.
基于血液及血液制品比例输注的大量输血方案的设计与实施是重要且活跃的研究领域。现有大量颇具争议的文献支持在大量输血中采用止血复苏法，同时也有新数据支持使用诸如重组凝血因子VIIa和氨甲环酸等辅助药物。我们回顾了过去5年大量输血研究的进展，包括方案实施、止血复苏、氨甲环酸的使用以及凝血障碍的目标导向治疗。此外，我们还对大量输血中成分疗法和重组凝血因子VIIa使用的数据进行了证据水平分析，给出了各种复苏药物的总结性建议以及目标导向治疗的新方法。
