Yamamoto Koji, Yamaguchi Atsushi, Sawano Makoto, Matsuda Masaki, Anan Masahiro, Inokuchi Koichi, Sugiyama Satoru
Department of Transfusion Medicine and Cell Therapy, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan.
Department of Emergency and Critical Care Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan.
Trauma Surg Acute Care Open. 2016 Dec 2;1(1):e000037. doi: 10.1136/tsaco-2016-000037. eCollection 2016.
Patients with severe trauma often present with critical coagulopathy, resulting in impaired hemostasis, massive hemorrhage, and a poor survival prognosis. The efficacy of hemostatic resuscitation in correcting coagulopathy and restoring tissue perfusion has not been studied. We assessed a novel approach of pre-emptive administration of fibrinogen concentrate to improve critical coagulopathy in patients with severe trauma.
We retrospectively compared blood transfusion volumes and survival prognosis between three groups of patients with trauma, with an Injury Severity Score (ISS) ≥26 over three consecutive periods: group A, no administration of fibrinogen concentrate; group B, administration of 3 g of fibrinogen concentrate after evaluation of trauma severity and a plasma fibrinogen level <1.5 g/L; group C, pre-emptive administration of 3 g of fibrinogen concentrate immediately on patient arrival based on prehospital information, including high-severity injury or assessed need for massive transfusion before measurement of fibrinogen.
∼56% of patients with an ISS ≥26 and transfused with red blood cell concentrates ≥10 units, had hypofibrinogenemia (fibrinogen <1.5 g/L) on arrival. Patients who received fibrinogen concentrate in group C showed significantly higher fibrinogen levels after treatment with this agent than those in group B (2.41 g/L vs 1.88 g/L; p=0.01). Although no significant difference was observed in blood transfusion volumes between the groups, the 30-day survival of patients in group C (all, and those with an ISS ≥26) was significantly better than in group A (p<0.05). The 48-hour mortality rate in patients with an ISS ≥26 was significantly lower in group C than in group A (8.6% vs 22.9%; p=0.005). Further, among patients with an ISS ≥41, the overall mortality was significantly lower in group C than in group A (20% vs 50%; p=0.02).
Pre-emptive administration of fibrinogen concentrate for patients with trauma with critical coagulopathy may contribute to improved survival.
Level IV.
严重创伤患者常出现严重凝血功能障碍，导致止血功能受损、大出血及生存预后不良。止血复苏在纠正凝血功能障碍和恢复组织灌注方面的疗效尚未得到研究。我们评估了一种预先给予纤维蛋白原浓缩物以改善严重创伤患者严重凝血功能障碍的新方法。
我们回顾性比较了三组创伤患者（损伤严重程度评分[ISS]≥26）在三个连续时期的输血量和生存预后：A组，未给予纤维蛋白原浓缩物；B组，在评估创伤严重程度且血浆纤维蛋白原水平<1.5 g/L后给予3 g纤维蛋白原浓缩物；C组，根据院前信息（包括重伤或评估有大量输血需求）在患者到达时立即预先给予3 g纤维蛋白原浓缩物，然后再测定纤维蛋白原。
ISS≥26且输注红细胞浓缩物≥10单位的患者中，约56%在到达时存在低纤维蛋白原血症（纤维蛋白原<1.5 g/L）。C组接受纤维蛋白原浓缩物治疗的患者在使用该药物治疗后纤维蛋白原水平显著高于B组（2.41 g/L对1.88 g/L；p = 0.01）。尽管各组之间输血量无显著差异，但C组患者（全部以及ISS≥26的患者）的30天生存率显著优于A组（p<0.05）。ISS≥26的患者中，C组的48小时死亡率显著低于A组（8.6%对22.9%；p = 0.005）。此外，在ISS≥41的患者中，C组的总体死亡率显著低于A组（20%对50%；p = 0.）。
对于有严重凝血功能障碍的创伤患者，预先给予纤维蛋白原浓缩物可能有助于提高生存率。
四级。
