Akasaki Yukio, Sugimori Hiroshi, Momii Kenta, Akahoshi Tomohiko, Matsuura Suguru, Iwamoto Yukihide, Maehara Yoshihiko, Hashizume Makoto
Emergency and Critical Care Center Kyushu University Hospital Fukuoka Japan.
Department of Orthopaedic Surgery Graduate School of Medical Sciences Kyushu University Fukuoka Japan.
Acute Med Surg. 2014 Oct 20;2(2):82-91. doi: 10.1002/ams2.74. eCollection 2015 Apr.
To recognize patients who require massive transfusion at the early stage of blunt trauma, we retrospectively investigated patients with high-energy blunt injuries transferred within 1 h post-trauma.
Between August 2007 and July 2011, 233 trauma patients were: (i) injured by a high-energy blunt mechanism with Injury Severity Score ≥9; (ii) not dead on arrival; (iii) older than 9 years; and (iv) at our center within 1 h after injury. The findings for 113 of those patients were analyzed, including those produced by ultrasonography, computed tomography, and arterial blood gas analyses.
Of 113 patients, 33 underwent massive transfusion (≥6 units) within 8 h of arrival. A logistic regression analysis revealed that an arterial lactate level ≥28 mg/dL ( < 0.001; odds ratio, 105.11; 95% confidence interval, 12.58-2,718.84) and a flat ratio of the inferior vena cava on computed tomography ≥3 ( < 0.001; odds ratio, 32.50; 95% confidence interval, 4.44-714.44) were significant independent predictors for a massive transfusion within 8 h. In a receiver operating curve analysis, the area under the curve of the need for massive transfusion was 0.956, with a sensitivity of 0.94 and a specificity of 0.90. A linear predictive formula for the probability (P) of receiving a massive transfusion was generated as P = 2 × lactate (mg/dL) + 15 × the flat ratio of inferior vena cava - 103. Using another 52 trauma patients, the formula was validated.
An elevated level of arterial lactate and the flat ratio of inferior vena cava were significant predictors for identifying the patients who would require a massive transfusion in the early stage after high-energy blunt trauma.
为了在钝性创伤早期识别出需要大量输血的患者，我们回顾性研究了创伤后1小时内转运的高能钝性损伤患者。
在2007年8月至2011年7月期间，233例创伤患者符合以下条件：（i）因高能钝性机制受伤，损伤严重程度评分≥9；（ii）到达时未死亡；（iii）年龄大于9岁；（iv）受伤后1小时内到达我们中心。对其中113例患者的检查结果进行分析，包括超声检查、计算机断层扫描和动脉血气分析结果。
113例患者中，33例在到达后8小时内接受了大量输血（≥6单位）。逻辑回归分析显示，动脉血乳酸水平≥28mg/dL（P<0.001；比值比，105.11；95%置信区间，12.58 - 2718.84）以及计算机断层扫描下腔静脉扁平率≥3（P<0.001；比值比，32.50；95%置信区间，4.44 - 714.44）是8小时内大量输血的显著独立预测因素。在受试者工作特征曲线分析中，大量输血需求曲线下面积为0.956，敏感性为0.94，特异性为0.90。生成了一个预测大量输血概率（P）的线性预测公式：P = 2×乳酸（mg/dL）+ 15×下腔静脉扁平率 - 103。使用另外52例创伤患者对该公式进行了验证。
动脉血乳酸水平升高和下腔静脉扁平率是识别高能钝性创伤后早期需要大量输血患者的显著预测因素。
