Hwang Kyungjin, Kwon Junsik, Cho Jayun, Heo Yunjung, Lee John Cook-Jong, Jung Kyoungwon
Division of Trauma, Department of Surgery, Ajou University School of Medicine and Graduate School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, Korea.
Department of Medical Humanities and Social Medicine, Ajou University School of Medicine and Graduate School of Medicine, Suwon, Gyeonggi-do, Korea.
World J Surg. 2018 Jul;42(7):2067-2075. doi: 10.1007/s00268-017-4441-5.
This study evaluated the effectiveness and clinical outcomes of the implementation of a trauma center and massive transfusion protocol (TCMTP) in a developing country without a well-established trauma system.
We included patients (1) aged >15 years, (2) with an Injury Severity Score >15, (3) who received ≥10 units of packed red blood cells (PRBCs) within 24 h, (4) who directly visited our institution from 2010 to 2016, and (5) who survived for ≥24 h. Patients treated during the post-TCMTP period (2015-2016) were compared with historical groups treated pre-TCMTP (2010-2012) and interim-TCMTP (2013-2014). Demographics, transfusion and fluid therapy performance, and clinical outcomes were compared between the three groups.
Overall, 190 patients were included: 64, 64, and 62 patients in the pre-TCMTP, interim-TCMTP, and post-TCMTP groups, respectively. Comparison between the three groups revealed significant differences in the fresh-frozen plasma/PRBC ratio (p = 0.001) and crystalloid infusion (p = 0.007); these variables gradually increased from pre- to post-TCMTP. Conversely, colloid infusion showed a reduction post-TCMTP (p < 0.001). Kaplan-Meier curves revealed that the 90-day survival rate was significantly higher in the post-TCMTP group (pre-TCMTP: 45.3 vs. 75.8%, p = 0.001; interim-TCMTP: 56.3 vs. 75.8%, p = 0.027). In Cox regression hierarchical survival analysis, TCMTP showed a hazard ratio for mortality of 0.380 after adjusting for all potentially confounding factors.
Our results suggest that building trauma centers and establishing a massive transfusion protocol according to the specific situations of a country will help improve outcomes for major trauma patients, even in developing countries without a well-established trauma system.
本研究评估了在一个尚未建立完善创伤系统的发展中国家实施创伤中心和大量输血方案（TCMTP）的有效性和临床结果。
我们纳入了符合以下条件的患者：（1）年龄>15岁；（2）损伤严重度评分>15；（3）在24小时内接受≥10单位的浓缩红细胞（PRBC）；（4）2010年至2016年直接就诊于我们机构；（5）存活≥24小时。将TCMTP实施后时期（2015 - 2016年）治疗的患者与TCMTP实施前（2010 - 2012年）和TCMTP实施中期（2013 - 2014年）治疗的历史组进行比较。比较三组患者的人口统计学、输血和液体治疗情况以及临床结果。
总体共纳入190例患者，其中TCMTP实施前组、实施中期组和实施后组分别有64例、64例和62例。三组之间的比较显示，新鲜冰冻血浆与PRBC的比例（p = 0.001）和晶体液输注量（p = 0.007）存在显著差异；这些变量从TCMTP实施前到实施后逐渐增加。相反，TCMTP实施后胶体液输注量减少（p < 0.001）。Kaplan - Meier曲线显示，TCMTP实施后组的90天生存率显著更高（TCMTP实施前：45.3%对75.8%，p = 0.001；TCMTP实施中期：56.3%对75.8%，p = 0.027）。在Cox回归分层生存分析中，在对所有潜在混杂因素进行调整后，TCMTP显示死亡风险比为0.380。
我们的结果表明，根据一个国家的具体情况建立创伤中心并制定大量输血方案，即使在尚未建立完善创伤系统的发展中国家，也将有助于改善严重创伤患者的治疗结果。
