在创伤和手术患者中，血浆与红细胞浓缩物的平衡输血比例是否能改善结局？随机对照试验和观察性研究的荟萃分析。
Does a balanced transfusion ratio of plasma to packed red blood cells improve outcomes in both trauma and surgical patients? A meta-analysis of randomized controlled trials and observational studies.
机构信息
Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA.
Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA.
出版信息
Am J Surg. 2018 Aug;216(2):342-350. doi: 10.1016/j.amjsurg.2017.08.045. Epub 2017 Sep 23.
BACKGROUND
The effect of high transfusion ratios of fresh frozen plasma (FFP): packed red blood cell (RBC) on mortality is still controversial. Observational evidence contradicts a recent randomized controlled trial regarding mortality benefit. This is an updated meta-analysis, including a non-trauma cohort.
METHODS
Patients were grouped into high vs. low based on FFP:RBC ratio. Primary outcomes were 24-h and 30-day/in-hospital mortality. Secondary outcomes were acute respiratory distress syndrome and acute lung injury rates. Random model and leave-one-out-analyses were used.
RESULTS
In 36 studies, lower ratio showed poorer 24-h and 30-day survival (p < 0.001). In trauma and non-trauma settings, a lower ratio was associated with worse 24-h and 30-day mortality (P < 0.001). A ratio of 1:1.5 provided the largest 24-h and 30-day survival benefit (p < 0.001). The ratio was not associated with ARDS or ALI.
CONCLUSIONS
High FFP:RBC ratio confers survival benefits in trauma and non-trauma settings, with the highest survival benefit at 1:1.5.
背景
大量输新鲜冰冻血浆（FFP）与红细胞（RBC）对死亡率的影响仍存在争议。观察性证据与最近的一项随机对照试验关于死亡率获益的结果相矛盾。这是一项更新的荟萃分析，包括非创伤队列。
方法
根据 FFP:RBC 比值将患者分为高比值组和低比值组。主要结局为 24 小时和 30 天/住院死亡率。次要结局为急性呼吸窘迫综合征（ARDS）和急性肺损伤（ALI）发生率。使用随机模型和逐一剔除分析。
结果
在 36 项研究中，较低的比值与较差的 24 小时和 30 天生存率相关（p<0.001）。在创伤和非创伤环境中，较低的比值与 24 小时和 30 天死亡率较高相关（P<0.001）。比值为 1:1.5 时，24 小时和 30 天生存率获益最大（p<0.001）。比值与 ARDS 或 ALI 无关。
结论
高 FFP:RBC 比值可在创伤和非创伤环境中带来生存获益，比值为 1:1.5 时获益最大。
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