Jansen J O, Morrison J J, Midwinter M J, Doughty H
144 Parachute Medical Squadron, 16 (Air Assault) Medical Regiment, and Aberdeen Royal Infirmary, Aberdeen, UK.
Transfus Med. 2014 Jun;24(3):154-61. doi: 10.1111/tme.12093. Epub 2013 Dec 24.
To document blood component usage in the UK medical treatment facility, Afghanistan, over a period of 4 years; and to examine the relationship with transfusion capability, injury pattern and survival.
Haemostatic resuscitation is now firmly established in military medical practice, despite the challenges of providing such therapy in austere settings.
Retrospective study of blood component use in service personnel admitted for trauma. Data were extracted from the UK Joint Theatre Trauma Registry.
A total of 2618 patients were identified. Survival increased from 76 to 84% despite no change in injury severity. The proportion of patients receiving blood components increased from 13 to 32% per annum; 417 casualties received massive transfusion (≥10 units of RCC), the proportion increasing from 40 to 62%. Use of all blood components increased significantly in severely injured casualties, to a median (IQR) of 16 (9-25) units of red cell concentrate (P = 0·006), 15 (8-24) of plasma (P = 0·002), 2 (0-5) of platelets (P < 0·001) and 1 (0-3) of cryoprecipitate (P < 0·001). Cryoprecipitate (P = 0·009) and platelet use (P = 0·005) also increased in moderately injured casualties.
The number of blood components transfused to individual combat casualties increased during the 4-year period, despite no change in injury severity or injury pattern. Survival also increased. Combat casualties requiring massive transfusion have a significantly higher chance of survival than civilian patients. Survival is the product of the entire system of care. However, we propose that the changes in military transfusion practice and capability have contributed to increased combat trauma survival.
记录英国在阿富汗的医疗设施中4年间血液成分的使用情况；并研究其与输血能力、损伤模式和生存率之间的关系。
尽管在艰苦环境中提供此类治疗存在挑战，但止血复苏现已在军事医疗实践中牢固确立。
对因创伤入院的服务人员使用血液成分的情况进行回顾性研究。数据从英国联合战区创伤登记处提取。
共识别出2618例患者。尽管损伤严重程度没有变化，但生存率从76%提高到了84%。接受血液成分输血的患者比例每年从13%增加到32%；417名伤员接受了大量输血（≥10单位红细胞悬液），比例从40%增加到62%。在重伤员中，所有血液成分的使用量均显著增加，红细胞浓缩液的中位数（四分位间距）为16（9 - 25）单位（P = 0·006），血浆为15（8 - 24）单位（P = 0·002），血小板为2（0 - 5）单位（P < 0·001），冷沉淀为1（0 - 3）单位（P < 0·001）。中度受伤的伤员中冷沉淀（P = 0·009）和血小板的使用量（P = 0·005）也有所增加。
在这4年期间，尽管损伤严重程度或损伤模式没有变化，但输往个体战斗伤员的血液成分数量增加了。生存率也有所提高。需要大量输血的战斗伤员的生存几率明显高于 civilian patients。生存是整个护理系统的产物。然而，我们认为军事输血实践和能力的变化有助于提高战斗创伤的生存率。
