Theusinger Oliver M, Stein Philipp, Spahn Donat R
Institute of Anesthesiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland.
Curr Opin Crit Care. 2014 Dec;20(6):646-55. doi: 10.1097/MCC.0000000000000152.
To point out the tolerance of anemia, the possible use of alternatives to allogeneic blood products as well as the pathophysiological effects of transfusions in the context of multiple trauma patients.
Restrictive transfusion triggers are beneficial for patient outcome in trauma.The actual European Trauma Treatment Guidelines suggest the use of point-of-care devices, the use of transfusion algorithms and factor concentrates to control coagulopathy. The use of high ratios of plasma to red blood cells to improve survival has been shown to suffer from a time-dependent survival bias. In massive bleeding, factor-based treatment of coagulopathy is feasible and preferable to plasma transfusion, if available. In nonmassive bleeding, allogeneic transfusion of blood products increases the appearance of serious adverse events and mortality and should be avoided unless clearly indicated.
Transfusion in trauma has to be an individual decision for a specific patient, not for a specific laboratory value. Transfusion management must aim at reducing or even avoiding the use of allogeneic blood products. This may lead to a new gold standard with cost reduction and amelioration of outcome of major trauma patients.
指出对贫血的耐受性、同种异体血制品替代物的可能用途以及在多发伤患者中输血的病理生理效应。
限制性输血触发阈值对创伤患者的预后有益。当前欧洲创伤治疗指南建议使用床旁检测设备、采用输血算法以及使用凝血因子浓缩剂来控制凝血功能障碍。已表明使用高比例血浆与红细胞来提高生存率存在时间依赖性生存偏倚。在大出血时，基于因子的凝血功能障碍治疗是可行的，并且如果有条件，比输注血浆更可取。在非大出血时，同种异体输血会增加严重不良事件的发生率和死亡率，除非有明确指征，否则应避免。
创伤输血必须针对特定患者进行个体化决策，而非基于特定实验室值。输血管理必须旨在减少甚至避免使用同种异体血制品。这可能会带来一个新的金标准，既能降低成本，又能改善严重创伤患者的预后。
