在严重创伤患者中使用法国冻干血浆输注与早期血浆输注和早期输血比例改善相关。

Use of French lyophilized plasma transfusion in severe trauma patients is associated with an early plasma transfusion and early transfusion ratio improvement.

机构信息

From the Department of Anesthesiology and Intensive Care (C.N., J.B., P.-J.C., P.E., M.C., Q.M., J.C., B.P., E.M.) and Emergency Department (S.B.), Military Hospital, Hôpital d'Instruction des Armées Sainte-Anne, France; and Centre de transfusion sanguine des armées (A.S.), Hôpital d'Instruction des Armées Percy, France.

出版信息

J Trauma Acute Care Surg. 2018 May;84(5):780-785. doi: 10.1097/TA.0000000000001801.

DOI:10.1097/TA.0000000000001801

PMID:29334571

Abstract

BACKGROUND

Early transfusion of high ratio of fresh frozen plasma (FFP) and red blood cells (RBC) is associated with mortality reduction. However, time to reach high ratio is limited by the need to thaw the FFP. French lyophilized plasma (FLYP) used by French army and available in military teaching hospital does not need to be thawed and is immediately available. We hypothesize that the use of FLYP may reduce time to reach a plasma/RBC ratio of 1:1.

METHODS

A retrospective study performed in a Level 1 trauma center between January 2012 and December 2015. Severe trauma patients who received 2 U of RBC in the emergency room were included and assigned to two groups according to first plasma transfused: FLYP group and FFP group.

RESULTS

Forty-three severe trauma patients in the FLYP group and 29 in the FFP group were included. The time until first plasma transfusion was shorter in the FLYP group than in the FFP group, respectively 15 min (10-25) versus 95 min (70-145) (p < 0.0001). Time until a 1:1 ratio was shorter in the FLYP group than in the FFP group. There were significantly fewer cases of massive transfusion in the FLYP group than in the FFP group with respectively 7% vs. 45% (p < 0.0001).

CONCLUSION

The use of FLYP provided significantly faster plasma transfusions than the use of FFP as well as a plasma and RBC ratio superior to 1:2 that was reached more rapidly in severe trauma patients. These results may explain the less frequent need for massive transfusion in the patients who received FLYP. These positive results should be confirmed by a prospective and randomized evaluation.

LEVEL OF EVIDENCE

Therapeutic, level IV.

摘要

背景

早期输注高比例新鲜冰冻血浆（FFP）和红细胞（RBC）与死亡率降低有关。然而，达到高比例的时间受到需要解冻 FFP 的限制。法国军队使用的冻干血浆（FLYP）和在军事教学医院中可用的 FLYP 不需要解冻，并且可以立即使用。我们假设使用 FLYP 可以减少达到血浆/RBC 比例为 1:1 的时间。

方法

这是一项在 2012 年 1 月至 2015 年 12 月期间在一级创伤中心进行的回顾性研究。在急诊室接受 2 单位 RBC 输注的严重创伤患者被纳入研究，并根据首次输注的血浆分为两组：FLYP 组和 FFP 组。

结果

FLYP 组纳入 43 例严重创伤患者，FFP 组纳入 29 例。FLYP 组的首次血浆输注时间明显短于 FFP 组，分别为 15 分钟（10-25）与 95 分钟（70-145）（p<0.0001）。FLYP 组达到 1:1 比例的时间也明显短于 FFP 组。FLYP 组大量输血的病例明显少于 FFP 组，分别为 7%与 45%（p<0.0001）。