Anand Tanya, Ramnanan Rajesh, Skinner Ruby, Martin Maureen
Department of Surgery, Kern Medical Center, Bakersfield, California, USA.
Am Surg. 2016 Oct;82(10):957-959.
Blood transfusions cause altered immunity and the duration of storage is contributory. In the era of massive transfusion protocols (MTPs) this impact is unclear, particularly as it relates to balanced transfusions. Trauma patients requiring our MTP after admission to our Level II trauma center were studied. The average age of blood transfused was calculated; old blood was a storage time of ≥14 days versus new blood <14 days. Blood to plasma ratios of 1:1 were compared with ratios >1:1. Infections, organ dysfunction multiorgan injury (MOI), and death were compared based on ratios and blood storage times. Of 2200 trauma admissions, 89 patients required MTP. Penetrating injuries were the majority, n = 53; and Injury Severity Score was 33 ± 14. Overall mortality was 31 per cent and sepsis was 28 per cent. Outcomes (storage time): Patients receiving old versus new blood had comparable age and Injury Severity Score. Sepsis rates, multiorgan injury and mortality were similar. Outcomes (packed red blood cells:fresh frozen plasma): Balanced transfusions (ratios of 1:1) demonstrated significant survival benefit and less infections compared with ratios >1:1. These data underscore the complexity of transfusion-related morbidity. In the modern era of MTP and balanced transfusions, the age of stored blood may not impact outcomes as demonstrated historically.
输血会导致免疫功能改变，而储存时间是一个影响因素。在大规模输血方案（MTP）时代，这种影响尚不清楚，尤其是与平衡输血相关的影响。我们对入住二级创伤中心后需要接受我们的MTP的创伤患者进行了研究。计算了输血的平均年龄；旧血的储存时间≥14天，而新血的储存时间<14天。将1:1的血液与血浆比例与>1:1的比例进行了比较。根据比例和血液储存时间比较了感染、器官功能障碍、多器官损伤（MOI）和死亡率。在2200例创伤入院患者中，89例需要MTP。穿透伤占大多数，n = 53；损伤严重度评分是33±14。总体死亡率为31%，败血症发生率为28%。结果（储存时间）：接受旧血与新血的患者年龄和损伤严重度评分相当。败血症发生率、多器官损伤和死亡率相似。结果（浓缩红细胞：新鲜冰冻血浆）：与比例>1:1相比，平衡输血（比例为1:1）显示出显著的生存益处且感染较少。这些数据强调了输血相关发病率的复杂性。在MTP和平衡输血的现代时代，储存血液的年龄可能不会像历史上所显示的那样影响结果。
