Simms Eric R, Hennings Dietric L, Hauch Adam, Wascom Julie, Fontenot Tatyana E, Hunt John P, McSwain Norman E, Meade Peter C, Myers Leann, Duchesne Juan C
Department of Surgery, Tulane University School of Medicine, New Orleans, LA.
Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA.
J Am Coll Surg. 2014 Aug;219(2):181-8. doi: 10.1016/j.jamcollsurg.2014.03.050. Epub 2014 May 2.
Whether high-ratio resuscitation (HRR) provides patients with survival advantage remains controversial. We hypothesized a direct correlation between HRR infusion rates in the first 180 minutes of resuscitation and survival.
This was a retrospective analysis of massively transfused trauma patients surviving more than 30 minutes and undergoing surgery at a level 1 trauma center. Mean infusion rates (MIR) of packed red blood cells (PRBC), fresh frozen plasma (FFP), and platelets (Plt) were calculated for length of intervention (emergency department [ED] time + operating room [OR] time). Patients were categorized as HRR (FFP:PRBC > 0.7, and/or Plts: PRBC > 0.7) vs low-ratio resuscitation (LRR). Student's t-tests and chi-square tests were used to compare survivors with nonsurvivors. Cox proportional hazards regression models and Kaplan-Meier curves were generated to evaluate the association between MIR for FFP:PRBC and Plt:PRBC and 180-minute survival.
There were 151 patients who met criteria: 121 (80.1%) patients survived 180 minutes (MIR:PRBC 71.9 mL/min, FFP 92.0 mL/min, Plt 3.5 mL/min) vs 30 (19.9%) who did not survive (MIR:PRBC 47.3 mL/min, FFP 33.7 mL/min, Plt 1.1 mL/min), p = 0.43, p < 0.0001 and p < 0.011, respectively. A Cox regression model evaluated PRBC rate, FFP rate, and Plt rate (mL/min) as mortality predictors within 180 minutes to assess if they significantly affected survival (hazard ratios 1.01 [p = 0.054], 0.97 [p < 0.0001], and 0.75 [p = 0.01], respectively). Another model used stepwise Cox regression including PRBC rate, FFP rate, and Plt rate (hazard ratios 1.00 [p = 0.85], 0.97 [p < 0.0001], and 0.88 [p = 0.24], respectively), as well as possible confounding variables.
This is the first study to examine effects of MIRs on survival. Further studies on the effects of narrow time-interval analysis for blood product resuscitation are warranted.
高比例复苏（HRR）是否能为患者带来生存优势仍存在争议。我们推测复苏开始180分钟内的HRR输注速率与生存之间存在直接关联。
这是一项对在一级创伤中心存活超过30分钟并接受手术的大量输血创伤患者的回顾性分析。计算了干预时长（急诊科[ED]时间+手术室[OR]时间）内的浓缩红细胞（PRBC）、新鲜冰冻血浆（FFP）和血小板（Plt）的平均输注速率（MIR）。患者被分为高比例复苏组（HRR，FFP:PRBC>0.7，和/或Plt:PRBC>0.7）和低比例复苏组（LRR）。采用学生t检验和卡方检验比较幸存者和非幸存者。生成Cox比例风险回归模型和Kaplan-Meier曲线，以评估FFP:PRBC和Plt:PRBC的MIR与180分钟生存率之间的关联。
有151例患者符合标准：121例（80.1%）患者存活180分钟（MIR:PRBC 71.9 mL/分钟，FFP 92.0 mL/分钟，Plt 3.5 mL/分钟），30例（19.9%）未存活（MIR:PRBC 47.3 mL/分钟，FFP 33.7 mL/分钟，Plt 1.1 mL/分钟），p分别为0.43、<0.0001和<0.011。一个Cox回归模型将PRBC速率、FFP速率和Plt速率（mL/分钟）作为180分钟内的死亡预测因素进行评估，以判断它们是否显著影响生存（风险比分别为1.01[p = 0.054]、0.97[p < 0.0001]和0.75[p = 0.01]）。另一个模型使用逐步Cox回归，包括PRBC速率、FFP速率和Plt速率（风险比分别为1.00[p = 0.85]、0.97[p < 0.0001]和0.88[p = 0.24]），以及可能的混杂变量。
这是第一项研究MIR对生存影响的研究。有必要进一步研究血液制品复苏的窄时间间隔分析的影响。
