Chang Ronald, Folkerson Lindley E, Sloan Duncan, Tomasek Jeffrey S, Kitagawa Ryan S, Choi H Alex, Wade Charles E, Holcomb John B
Center for Translational Injury Research, University of Texas Health Science Center, Houston, TX; Department of Surgery, University of Texas Health Science Center, Houston, TX.
Center for Translational Injury Research, University of Texas Health Science Center, Houston, TX; Department of Surgery, University of Texas Health Science Center, Houston, TX.
Surgery. 2017 Feb;161(2):538-545. doi: 10.1016/j.surg.2016.08.023. Epub 2016 Oct 21.
Plasma-based resuscitation improves outcomes in trauma patients with hemorrhagic shock, while large-animal and limited clinical data suggest that it also improves outcomes and is neuroprotective in the setting of combined hemorrhage and traumatic brain injury. However, the choice of initial resuscitation fluid, including the role of plasma, is unclear for patients after isolated traumatic brain injury.
We reviewed adult trauma patients admitted from January 2011 to July 2015 with isolated traumatic brain injury. "Early plasma" was defined as transfusion of plasma within 4 hours. Purposeful multiple logistic regression modeling was performed to analyze the relationship of early plasma and inhospital survival. After testing for interaction, subgroup analysis was performed based on the pattern of brain injury on initial head computed tomography: epidural hematoma, intraparenchymal contusion, subarachnoid hemorrhage, subdural hematoma, or multifocal intracranial hemorrhage.
Of the 633 isolated traumatic brain injury patients included, 178 (28%) who received early plasma were injured more severely coagulopathic, hypoperfused, and hypotensive on admission. Survival was similar in the early plasma versus no early plasma groups (78% vs 84%, P = .08). After adjustment for covariates, early plasma was not associated with improved survival (odds ratio 1.18, 95% confidence interval 0.71-1.96). On subgroup analysis, multifocal intracranial hemorrhage was the largest subgroup with 242 patients. Of these, 61 (25%) received plasma within 4 hours. Within-group logistic regression analysis with adjustment for covariates found that early plasma was associated with improved survival (odds ratio 3.34, 95% confidence interval 1.20-9.35).
Although early plasma transfusion was not associated with improved in-hospital survival for all isolated traumatic brain injury patients, early plasma was associated with increased in-hospital survival in those with multifocal intracranial hemorrhage.
基于血浆的复苏可改善创伤性失血性休克患者的预后，而大型动物实验和有限的临床数据表明，在合并出血和创伤性脑损伤的情况下，它也能改善预后并具有神经保护作用。然而，对于单纯创伤性脑损伤后的患者，初始复苏液体的选择，包括血浆的作用，尚不清楚。
我们回顾了2011年1月至2015年7月收治的成年单纯创伤性脑损伤患者。“早期血浆”定义为在4小时内输注血浆。进行有目的的多因素逻辑回归建模，以分析早期血浆与院内生存率的关系。在进行交互作用检验后，根据初始头部计算机断层扫描的脑损伤模式进行亚组分析：硬膜外血肿、脑实质内挫伤、蛛网膜下腔出血、硬膜下血肿或多灶性颅内出血。
在纳入的633例单纯创伤性脑损伤患者中，178例（28%）接受早期血浆治疗的患者入院时凝血功能障碍、灌注不足和低血压情况更严重。早期血浆组与非早期血浆组的生存率相似（78%对84%，P = 0.08）。在对协变量进行调整后，早期血浆与生存率改善无关（优势比1.18，95%置信区间0.71 - 1.96）。亚组分析中，多灶性颅内出血是最大的亚组，有242例患者。其中，61例（25%）在4小时内接受了血浆治疗。在对协变量进行调整的组内逻辑回归分析中发现，早期血浆与生存率提高相关（优势比3.34，95%置信区间1.20 - 9.35）。
虽然早期血浆输注对所有单纯创伤性脑损伤患者的院内生存率改善无显著影响，但早期血浆输注与多灶性颅内出血患者的院内生存率提高相关。
