Duchesne Juan C, Guidry Chrissy, Hoffman Jordan R H, Park Timothy S, Bock Jiselle, Lawson Sarah, Meade Peter, McSwain Norman E
Tulane University Health Science Center, New Orleans, LA, USA.
Am Surg. 2012 Sep;78(9):936-41.
The impact on outcomes resulting from crystalloids used with hemostatic close ratio resuscitation (HCRR) in intraoperative hemorrhage (IOH) has not been analyzed. We hypothesize a survival advantage in patients with IOH managed with a low-volume resuscitation (LVR) protocol during HCRR. A 4-year case-control study was conducted to determine the impact on mortality of LVR versus conventional resuscitation efforts (CRE) during HCRR. A total of 45 patients managed with a HCRR + LVR protocol (combination Hextend® and 3% hypertonic saline) and 55 historical cohorts managed with HCRR + CRE (lactated Ringer's) were included. Patient demographics, number of intraoperative units of packed red blood cells (PRBCs) and fresh-frozen plasma (FFP) received, and FFP:PRBC ratio were similar between groups. The mean intraoperative fluid volume was 0.76 L in the HCRR + LVR group versus 4.7 L in the HCRR + CRE group (P = 0.003). In a linear regression model HCRR + LVR versus HCRR + CRE, mean trauma intensive care unit length of stay was 6 versus 11 days (P = 0.009); 30-day overall mortality was 11.1 versus 32.7 per cent (P = 0.009); perioperative mortality was 2.2 to 10.9 per cent (P = 0.13); and intensive care unit mortality 8.8 to 21.8 per cent (P = 0.07). LVR protocol conveyed a survival benefit to patients undergoing HCRR (odds ratio for mortality, 0.07 [95% confidence interval 0.07-0.54]). This is the first civilian study to analyze the impact of LVR in patients managed with HCRR during IOH. Patients with IOH managed with HCRR and a predefined LVR protocol with Hextend® and 3 per cent hypertonic saline had an overall survival advantage and shorter trauma intensive care unit length of stay. LVR can be an effective alternative to CRE when used in combination with HCRR in patients with IOH.
术中出血（IOH）时使用晶体液进行止血性接近比例复苏（HCRR）对治疗结果的影响尚未得到分析。我们假设在HCRR期间采用小容量复苏（LVR）方案治疗的IOH患者具有生存优势。进行了一项为期4年的病例对照研究，以确定HCRR期间LVR与传统复苏措施（CRE）对死亡率的影响。共纳入45例采用HCRR + LVR方案（联合使用贺斯®和3%高渗盐水）治疗的患者以及55例采用HCRR + CRE方案（乳酸林格氏液）治疗的历史队列患者。两组患者的人口统计学特征、术中输注的浓缩红细胞（PRBC）单位数量和新鲜冰冻血浆（FFP）数量以及FFP:PRBC比例相似。HCRR + LVR组的术中平均液体量为0.76 L，而HCRR + CRE组为4.7 L（P = 0.003）。在HCRR + LVR与HCRR + CRE的线性回归模型中，创伤重症监护病房的平均住院时间分别为6天和11天（P = 0.009）；30天总死亡率分别为11.1%和32.7%（P = 0.009）；围手术期死亡率分别为2.2%和[10.9%（P = 0.13）]；重症监护病房死亡率分别为8.8%和21.8%（P = 0.07）。LVR方案为接受HCRR治疗的患者带来了生存益处（死亡比值比为0.07 [95%置信区间0.07 - 0.54]）。这是第一项分析LVR对IOH期间接受HCRR治疗患者影响的平民研究。采用HCRR和预先定义的LVR方案（联合使用贺斯®和3%高渗盐水）治疗的IOH患者具有总体生存优势，且创伤重症监护病房住院时间更短。在IOH患者中，LVR与HCRR联合使用时可成为CRE的有效替代方案。
