Söderlund T, Ketonen T, Handolin L
1 Trauma Unit, Department of Orthopedics and Traumatology, Töölö Hospital, Helsinki University Central Hospital and Academic Medical Center Helsinki, Helsinki, Finland.
2 Department of Radiology, Töölö Hospital, Helsinki University Central Hospital and Academic Medical Center Helsinki, Helsinki, Finland.
Scand J Surg. 2017 Sep;106(3):255-260. doi: 10.1177/1457496916683092. Epub 2017 Mar 1.
Massive transfusion protocol seems to improve outcome in massively bleeding trauma patients, but not pelvic fracture patients. The aim of this study was to evaluate the effect of massive transfusion protocol on the mortality and fluid resuscitation of shocked pelvic fracture patients.
This is a trauma register study from a single hospital. From the trauma registry patients with pelvic fracture, injury severity score >15, admission base excess below -5, age >15 years, blunt trauma, and primary admission from the scene were identified. Patients were divided into two groups: Group 1-pre-massive transfusion protocol (2006-2009) and Group 2-post-massive transfusion protocol (2010-2013). Basic characteristics and intensive care unit length of stay, mortality, and fluid resuscitation data were retrieved from the registry. Standardized mortality ratio was assessed using revised injury severity classification, version II methodology.
Altogether, 102 patients were identified. Group 1 ( n = 56) and Group 2 ( n = 46) were comparable in their basic characteristics. The observed mortality was 35.7% and 26.1% in Groups 1 and 2, respectively. The standardized mortality ratio failed to reveal any difference between observed and expected mortality in either group. In the emergency room, the use of crystalloids decreased from 5.3 ± 3.4 to 3.3 ± 1.8 L ( p = 0.002) with increased use of fresh frozen plasma (2.9 ± 4.4 vs 5.1 ± 5.3, p = 0.007).
No improvement in the adjusted survival of shocked pelvic fracture patients is apparent after implementation of massive transfusion protocol. Implementation of massive transfusion protocol is associated with a higher use of fresh frozen plasma and improved ratio of fresh frozen plasma:red blood cell toward the targeted 1:1 and decreased use of crystalloids.
大量输血方案似乎能改善大量出血创伤患者的预后，但对骨盆骨折患者无效。本研究旨在评估大量输血方案对休克骨盆骨折患者死亡率和液体复苏的影响。
这是一项来自单一医院的创伤登记研究。从创伤登记中确定骨盆骨折、损伤严重程度评分>15、入院碱剩余低于-5、年龄>15岁、钝性创伤且从现场直接入院的患者。患者分为两组：第1组——大量输血方案实施前（2006 - 2009年）和第2组——大量输血方案实施后（2010 - 2013年）。从登记处获取基本特征、重症监护病房住院时间、死亡率和液体复苏数据。使用修订的损伤严重程度分类II版方法评估标准化死亡率。
共确定102例患者。第1组（n = 56）和第2组（n = 46）的基本特征具有可比性。第1组和第2组的观察到的死亡率分别为35.7%和26.1%。标准化死亡率未能显示两组中观察到的死亡率与预期死亡率之间存在任何差异。在急诊室，晶体液的使用量从5.3±3.4升降至3.3±1.8升（p = 0.002），同时新鲜冰冻血浆的使用量增加（2.9±4.4对5.1±5.3，p = 0.007）。
实施大量输血方案后，休克骨盆骨折患者的校正生存率未见明显改善。大量输血方案的实施与新鲜冰冻血浆使用量增加、新鲜冰冻血浆与红细胞比例朝着目标1:1改善以及晶体液使用量减少有关。
