老年创伤患者的输血与凝血功能障碍
Blood transfusion and coagulopathy in geriatric trauma patients.
作者信息
Mador Brett, Nascimento Bartolomeu, Hollands Simon, Rizoli Sandro
机构信息
Department of Surgery, University of Alberta, 205 - 3017 66 St NW, Edmonton, AB, T6K 4B2, Canada.
Department of Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Room H171, Toronto, ON, M4N 3M5, Canada.
出版信息
Scand J Trauma Resusc Emerg Med. 2017 Mar 29;25(1):33. doi: 10.1186/s13049-017-0374-0.
BACKGROUND
Trauma resuscitation has undergone a paradigm shift with new emphasis on the early use of blood products and increased proportions of plasma and platelets. However, it is unclear how this strategy is applied or how effective it is in the elderly population. The study aim is to identify differences in transfusion practices and the coagulopathy of trauma in the elderly.
METHODS
Data was prospectively collected on all consecutive patients that met trauma activation criteria at a Level I trauma centre. Data fields included patient demographics, co-morbidities, injury and resuscitation data, laboratory values, thromboelastography (TEG) results, and outcome measures. Elderly patients were defined as those 55 and older. Propensity-score matched analysis was completed for patients receiving blood product transfusion. Patients were matched by gender, mechanism, injury severity score (ISS), head injury, and time from injury.
RESULTS
Total of 628 patients were included, of which 142 (23%) were elderly. Elderly patients were more likely to be female (41% vs. 24%), suffer blunt mechanism of trauma (96% vs. 80%), have higher ISS scores (mean 25.4 vs. 21.6) and mortality (19% vs. 8%). Elderly patients were significantly more likely to receive a blood transfusion (42% vs. 30%), specifically for red cells and plasma. Propensity-matched analysis resulted in no difference in red cell transfusion or mortality. Despite the broad similarities between the matched cohorts, trauma coagulopathy as measured by TEG was less commonly observed in the elderly.
DISCUSSION
Our results suggest that elderly trauma patients are more likely to receive blood products when admitted to a trauma centre, though this may be attributed to under-triage. The results also suggest an altered coagulopathic response to traumatic injury which is partially influenced by increased anticoagulant and antiplatelet medication use in the geriatric population.
CONCLUSION
It is not clear whether the acute coagulopathy of trauma is equivalent in geriatric patients, and further study is therefore warranted.
背景
创伤复苏已发生范式转变，新的重点是早期使用血液制品以及增加血浆和血小板的比例。然而，尚不清楚该策略如何应用，以及在老年人群中效果如何。本研究的目的是确定老年患者输血实践和创伤性凝血病的差异。
方法
前瞻性收集了一级创伤中心所有符合创伤激活标准的连续患者的数据。数据字段包括患者人口统计学、合并症、损伤和复苏数据、实验室值、血栓弹力图（TEG）结果以及结局指标。老年患者定义为年龄在55岁及以上者。对接受血液制品输血的患者进行倾向评分匹配分析。患者按性别、受伤机制、损伤严重程度评分（ISS）、头部损伤和受伤时间进行匹配。
结果
共纳入628例患者，其中142例（23%）为老年患者。老年患者更可能为女性（41%对24%），遭受钝性创伤机制（96%对80%），ISS评分更高（平均25.4对21.6）且死亡率更高（19%对8%）。老年患者接受输血的可能性显著更高（42%对30%），尤其是红细胞和血浆。倾向匹配分析显示红细胞输血或死亡率无差异。尽管匹配队列之间有广泛相似之处，但通过TEG测量的创伤性凝血病在老年患者中较少见。
讨论
我们的结果表明，老年创伤患者入院时更可能接受血液制品，不过这可能归因于分诊不足。结果还表明，对创伤性损伤的凝血病反应有所改变，这部分受老年人群中抗凝和抗血小板药物使用增加的影响。
结论
尚不清楚老年患者的创伤急性凝血病是否相同，因此有必要进一步研究。
Zotero 插件