US Army Institute of Surgical Research, Fort Sam Houston, Texas, USA.
J Trauma Acute Care Surg. 2012 Dec;73(6 Suppl 5):S445-52. doi: 10.1097/TA.0b013e3182754796.
The Joint Theater Trauma Registry database, begun early in Operation Iraqi Freedom and Operation Enduring Freedom, created a comprehensive repository of information that facilitated research efforts and produced rapid changes in clinical care. New clinical practice guidelines were adopted throughout the last decade. The damage-control resuscitation clinical practice guideline sought to provide high-quality blood products in support of tissue perfusion and hemostasis. The goal was to reduce death from hemorrhagic shock in patients with severe traumatic bleeding. This 10-year review of the Joint Theater Trauma Registry database reports the military's experience with resuscitation and coagulopathy, evaluates the effect of increased plasma and platelet (PLT)-to-red blood cell ratios, and analyzes other recent changes in practice.
Records of US active duty service members at least 18 years of age who were admitted to a military hospital from March 2003 to February 2012 were entered into a database. Those who received at least one blood product (n = 3,632) were included in the analysis. Data were analyzed with respect to interactions within and between categories (demographics, admission characteristics, hospital course, and outcome). Transfusions were analyzed with respect to time, survival, and effect of increasing transfusion ratios.
Coagulopathy was prevalent upon presentation (33% with international normalized ratio ≥ 1.5), correlated with increased mortality (fivefold higher), and was associated with the need for massive transfusion. High transfusion ratios of fresh frozen plasma and PLT to red blood cells were correlated with higher survival but not decreased blood requirement. Survival was most correlated with PLT ratio, but high fresh frozen plasma ratio had an additive effect (PLT odds ratio, 0.22).
This 10-year evaluation supports earlier studies reporting the benefits of damage-control resuscitation strategies in military casualties requiring massive transfusion. The current analysis suggests that defects in PLT function may contribute to coagulopathy of trauma.
Epidemiologic study, level IV.
联合战区创伤登记数据库始于伊拉克自由行动和持久自由行动早期，创建了一个全面的信息库，促进了研究工作，并迅速改变了临床护理。新的临床实践指南在过去十年中得到了采用。控制性复苏临床实践指南旨在提供高质量的血液制品，以支持组织灌注和止血。其目标是减少严重创伤性出血患者的失血性休克死亡。本研究对联合战区创伤登记数据库进行了 10 年回顾，报告了军队在复苏和凝血功能障碍方面的经验，评估了增加血浆和血小板（PLT）与红细胞比值的效果，并分析了其他近期实践中的变化。
将 2003 年 3 月至 2012 年 2 月期间至少 18 岁的美国现役军人的住院记录输入数据库。将至少接受过一种血液制品（n=3632）的患者纳入分析。对数据进行了分析，以了解各分类内和分类间的相互作用（人口统计学、入院特征、住院过程和结果）。根据时间、存活率和增加输血比例的效果分析了输血情况。
入院时凝血功能障碍很常见（国际标准化比值≥1.5 的患者占 33%），与死亡率增加（高 5 倍）相关，与大量输血需求相关。新鲜冷冻血浆和 PLT 与红细胞的高输血比例与较高的存活率相关，但与血液需求减少无关。存活率与 PLT 比值最相关，但高新鲜冷冻血浆比值有附加效果（PLT 比值优势比为 0.22）。
这项为期 10 年的评估支持了先前关于在需要大量输血的军事伤员中采用控制性复苏策略的好处的研究报告。目前的分析表明，血小板功能缺陷可能导致创伤性凝血病。
流行病学研究，IV 级。
