复苏开始后180分钟内新鲜冰冻血浆和血小板输注速率的影响

Impact of infusion rates of fresh frozen plasma and platelets during the first 180 minutes of resuscitation.

作者信息

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

机构信息

Department of Surgery, Tulane University School of Medicine, New Orleans, LA.

Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA.

出版信息

J Am Coll Surg. 2014 Aug;219(2):181-8. doi: 10.1016/j.jamcollsurg.2014.03.050. Epub 2014 May 2.

DOI:10.1016/j.jamcollsurg.2014.03.050

PMID:24974265

Abstract

BACKGROUND

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.

STUDY DESIGN

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.

RESULTS

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.

CONCLUSIONS

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.

摘要

背景

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。

研究设计

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。

结果

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。