Keneally Ryan J, Parsons Andrew M, Willett Peter B
Department of Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
J Emerg Trauma Shock. 2015 Jan-Mar;8(1):21-5. doi: 10.4103/0974-2700.150392.
Thoracic trauma occurred in 10% of the patients seen at US military treatment facilities in Iraq and Afghanistan and 52% of those patients were transfused. Among those transfused, 281 patients received warm fresh whole blood. A previous report documented improved survival with warm fresh whole blood in patients injured in combat without stratification by injury pattern. A later report described an increase in acute lung injuries after its administration. Survivorship and warm fresh whole blood have never been analyzed in a subpopulation at highest risk for lung injuries, such as patients with thoracic trauma. There may be a heterogeneous relationship between whole blood and survival based on likelihood of a concomitant pulmonary injury. In this report, the relationship between warm fresh whole blood and survivorship was analyzed among patients at highest risk for concomitant pulmonary injuries.
Patients with thoracic trauma who received a transfusion were identified in the Joint Theater Trauma Registry. Gross mortality rates were compared between whole blood recipients and patients transfused with component therapy only. The association between each blood component and mortality was determined in a regression model. The overall mortality risk was compared between warm fresh whole blood recipients and non-recipients.
Patients transfused with warm fresh whole blood in addition to component therapy had a higher mortality rate than patients transfused only separated blood components (21.3% vs. 12.8%, P < 0.001). When controlling for covariates, transfusion of warm fresh whole blood in addition to component therapy was not associated with increased mortality risk compared with the transfusion of component therapy only (OR 1.247 [95% CI 0.760-2.048], P = 0.382).
Patients with combat related thoracic trauma transfused with warm fresh whole blood were not at increased risk for mortality compared to those who received component therapy alone when controlling for covariates.
在伊拉克和阿富汗的美国军事治疗机构所接诊的患者中，10%发生了胸部创伤，其中52%的患者接受了输血治疗。在这些接受输血的患者中，有281例接受了温热新鲜全血输血。此前有报告称，在战斗中受伤的患者中，温热新鲜全血输血可提高生存率，但未按损伤类型进行分层。后来有报告称，输注温热新鲜全血后急性肺损伤有所增加。对于肺损伤风险最高的亚组人群，如胸部创伤患者，尚未对其生存率与温热新鲜全血输血进行分析。基于合并肺部损伤的可能性，全血与生存率之间可能存在异质性关系。在本报告中，分析了合并肺部损伤风险最高的患者中温热新鲜全血与生存率之间的关系。
在联合战区创伤登记处中识别出接受输血治疗的胸部创伤患者。比较全血接受者与仅接受成分输血治疗患者的总死亡率。在回归模型中确定每种血液成分与死亡率之间的关联。比较温热新鲜全血接受者与未接受者的总体死亡风险。
除成分输血治疗外还接受温热新鲜全血输血的患者死亡率高于仅接受分离血液成分输血的患者（21.3%对12.8%，P<0.001）。在控制协变量后，除成分输血治疗外还输注温热新鲜全血与仅输注成分输血治疗相比，并未增加死亡风险（比值比1.247[95%置信区间0.760 - 2.048]，P = 0.382）。
在控制协变量后，与仅接受成分输血治疗的患者相比，接受温热新鲜全血输血的战斗相关胸部创伤患者死亡风险并未增加。
