May L Andrew, Harrell Kevin N, Bell Christopher M, Basham-Saif Angela, Barker Donald E, Maxwell Robert A
From the *University of Tennessee College of Medicine Chattanooga, Chattanooga, Tennessee.
†William Beaumont Army Medical Center, El Paso, Texas; and.
Am Surg. 2020 Jan 1;86(1):35-41.
A massive transfusion protocol (MTP) was implemented at a Level I trauma center in 2007 for patients with massive blood loss. A goal ratio of plasma to pheresed platelets to packed red blood cells (PRBCs) of 1:1:1 was established. From 2007 to 2014, trauma nurse clinicians (TNCs) administered the MTP during initial resuscitation and anesthesia personnel administered the MTP intraoperatively. In 2015, TNCs began administering the MTP intraoperatively. This study evaluates intraoperative blood product ratios and crystalloid volume administered by anesthesia personnel or TNCs. A retrospective review of trauma registry patients requiring MTP from 2007 to 2017 was performed. Patient data were stratified according to MTP administration by either anesthesia personnel (2007-2015) or TNCs (2015-2017). Ninety-seven patients were included with 54 anesthesia patients and 44 TNC patients. Patients undergoing resuscitation by MTP administered by TNCs received less median crystalloid (3000 mL 1500 mL, < 0.001). The ratio of plasma:PRBC (0.75 0.93, = 0.027) and platelets:PRBC (0.75 1.04, = 0.003) was found to be significantly closer to 1:1 for TNC patients. MTP intraoperative blood product administration by TNCs reduced the amount of infused crystalloid and improved adherence to MTP in achieving a 1:1:1 ratio of blood products.
2007年，一家一级创伤中心针对大量失血患者实施了大量输血方案（MTP）。设定了血浆与单采血小板与浓缩红细胞（PRBC）的目标比例为1:1:1。2007年至2014年期间，创伤护士临床医生（TNC）在初始复苏期间实施MTP，麻醉人员在术中实施MTP。2015年，TNC开始在术中实施MTP。本研究评估了麻醉人员或TNC术中输注的血液制品比例和晶体液量。对2007年至2017年需要MTP的创伤登记患者进行了回顾性研究。患者数据根据麻醉人员（2007 - 2015年）或TNC（2015 - 2017年）实施的MTP进行分层。纳入97例患者，其中54例为麻醉组患者，44例为TNC组患者。由TNC实施MTP进行复苏的患者接受的中位晶体液较少（3000 mL对1500 mL，P<0.001）。发现TNC组患者的血浆:PRBC比例（0.75对0.93，P = 0.027）和血小板:PRBC比例（0.75对1.04，P = 0.003）明显更接近1:1。TNC进行MTP术中血液制品输注减少了晶体液输注量，并提高了在实现血液制品1:1:1比例方面对MTP的依从性。
