Kragh John F, Nam Jason J, Berry Keith A, Mase Vincent J, Aden James K, Walters Thomas J, Dubick Michael A, Baer David G, Wade Charles E, Blackbourne Lorne H
Damage Control Resuscitation; Uniformed Services University of the Health Sciences, F. Edward Hébert School of Medicine, Bethesda, MD.
Walter Reed National Military Medical Center, Bethesda, MD.
Ann Emerg Med. 2015 Mar;65(3):290-6. doi: 10.1016/j.annemergmed.2014.10.021. Epub 2014 Nov 24.
We assess whether emergency tourniquet use for transfused war casualties admitted to military hospitals is associated with survival.
A retrospective review of trauma registry data was made of US casualties in Afghanistan and Iraq. Patients with major limb trauma, transfusion, and tourniquet use were compared with similar patients who did not receive tourniquet use. A propensity-matching analysis was performed by stratifying for injury type and severity by tourniquet-use status. Additionally, direct comparison without propensity matching was made between tourniquet use and no-tourniquet use groups.
There were 720 casualties in the tourniquet use and 693 in the no-tourniquet use groups. Of the 1,413 casualties, 66% (928) also had nonextremity injury. Casualties with tourniquet use had worse signs of hemorrhagic shock (admission base deficit, admission hemoglobin, admission pulse, and transfusion units required) than those without. Survival rates were similar between the 2 groups (1% difference; 95% confidence interval -2.5% to 4.2%), but casualties who received tourniquets had worse shock and received more blood products. In propensity-matched casualties, survival rates were not different (2% difference; 95% confidence interval -6.7% to 2.7%) between the 2 groups.
Tourniquet use was associated with worse shock and more transfusion requirements among hospital-admitted casualties, yet those who received tourniquets had survival rates similar to those of comparable, transfused casualties who did not receive tourniquets.
我们评估在军事医院收治的接受输血治疗的战争伤员中，使用紧急止血带是否与生存相关。
对阿富汗和伊拉克的美国伤员的创伤登记数据进行回顾性分析。将有严重肢体创伤、接受输血治疗且使用止血带的患者与未使用止血带的类似患者进行比较。通过根据止血带使用情况对损伤类型和严重程度进行分层，进行倾向匹配分析。此外，在使用止血带组和未使用止血带组之间进行了无倾向匹配的直接比较。
使用止血带组有720名伤员，未使用止血带组有693名伤员。在这1413名伤员中，66%（928名）还伴有非肢体损伤。使用止血带的伤员比未使用止血带的伤员有更严重的失血性休克迹象（入院碱缺失、入院血红蛋白、入院脉搏以及所需输血量）。两组的生存率相似（差异为1%；95%置信区间为-2.5%至4.2%），但使用止血带的伤员休克情况更严重，接受的血液制品更多。在倾向匹配的伤员中，两组的生存率没有差异（差异为2%；95%置信区间为-6.7%至2.7%）。
在医院收治的伤员中，使用止血带与更严重的休克和更多的输血需求相关，但使用止血带的伤员的生存率与未使用止血带的类似输血伤员的生存率相似。
