遵循大量输血方案（MTP）会影响患者的治疗结果。

Compliance with a massive transfusion protocol (MTP) impacts patient outcome.

作者信息

Bawazeer M, Ahmed N, Izadi H, McFarlan A, Nathens A, Pavenski K

机构信息

Trauma Program and Transfusion Medicine, Departments of Surgery and Laboratory Medicine, St. Michael's Hospital, University of Toronto, Canada.

出版信息

Injury. 2015 Jan;46(1):21-8. doi: 10.1016/j.injury.2014.09.020. Epub 2014 Oct 5.

DOI:10.1016/j.injury.2014.09.020

PMID:25452004

Abstract

BACKGROUND

About 5% of civilian trauma requires massive transfusion. Protocolized resuscitation with blood products to achieve high plasma:RBC ratio has been advocated to improve survival. Our objectives were to measure compliance to our institutional MTP, to identify quality assurance activities that could improve protocol compliance and to determine if protocol compliance was related to patient outcome.

METHODS

The investigators determined 13 compliance criteria based upon our institutional protocol. We measured compliance in 72 consecutive MTP activations between January 2010 and September 2011 at a Level I trauma centre. Data elements were retrospectively retrieved from blood bank, trauma registry and clinical records. Patients were stratified into three groups based on compliance level, and mortality differences were compared.

RESULTS

Average compliance for the cohort (n=72) was 66%. The most common cause of non-compliance was failure to send a complete haemorrhage panel from the trauma bay (96%). Failure to monitoring blood work every 30min occurred in 89% of cases. Delay in activation and deactivation occurred in 50% and 50% respectively. Non-compliance to protocol-based administration of blood products happened in 47%. The cohort was stratified into three groups based on compliance, A: <60%, B: 60-80% and C: >80% (low, moderate and high compliance groups). There was no statistical significance with regard to median age, median ISS, ED SBP, ED GCS and AIS of the head/spine, chest and abdomen. The mortality rates in each group were 62%, 50% and 10% in the low, moderate and high compliance groups respectively. Mortality differences were compared using adjusted logistic regression. The OR for mortality between Groups A and B=1.1 [95% CI 0.258-4.687 (P=0.899)] while the OR for mortality between Groups C and B=0.02 [95% CI <0.001-0.855 (P=0.041)].

CONCLUSIONS

Measures should be directed towards provider and system factors to improve compliance. In this study, there was an association between survival and higher level of compliance.

摘要

背景

约5%的平民创伤需要大量输血。有人主张采用血液制品进行规范化复苏以实现高血浆与红细胞比例，从而提高生存率。我们的目标是衡量对我院大量输血方案（MTP）的依从性，确定可提高方案依从性的质量保证活动，并确定方案依从性是否与患者预后相关。

方法

研究人员根据我院方案确定了13项依从性标准。我们在一家一级创伤中心对2010年1月至2011年9月期间连续72次激活的MTP的依从性进行了测量。数据元素从血库、创伤登记处和临床记录中进行回顾性检索。根据依从性水平将患者分为三组，并比较死亡率差异。

结果

该队列（n = 72）的平均依从率为66%。最常见的不依从原因是未能从创伤室送检完整的出血检查项目（96%）。89%的病例未每30分钟监测一次血液检查结果。激活延迟和停用延迟分别发生在50%和50%的病例中。47%的病例未按照方案使用血液制品。根据依从性将该队列分为三组，A组：<60%，B组：60 - 80%，C组：>80%（低、中、高依从性组）。在中位年龄、中位损伤严重度评分（ISS）、急诊收缩压（ED SBP）、急诊格拉斯哥昏迷评分（ED GCS）以及头部/脊柱、胸部和腹部的简明损伤定级（AIS）方面，无统计学意义。低、中、高依从性组的死亡率分别为62%、50%和10%。使用校正逻辑回归比较死亡率差异。A组与B组之间的死亡比值比（OR）=1.1 [95%可信区间（CI）0.258 - 4.687（P = 0.899）]，而C组与B组之间的死亡OR = 0.02 [95% CI <0.001 - 0.855（P = 0.041）]。