比较大量输血患儿血液制品不平衡与平衡比例：对死亡率和结局的影响。
Comparing unbalanced and balanced ratios of blood products in massive transfusion to pediatric trauma patients: effects on mortality and outcomes.
机构信息
Department of Surgery, Division of Trauma, Burns, Surgical Critical Care, and Acute Care Surgery, University of California, Irvine, Orange, CA, USA.
Irvine Medical Center, University of California, 1001 Health Sciences Rd, Irvine, CA, 92617, USA.
出版信息
Eur J Trauma Emerg Surg. 2022 Feb;48(1):179-186. doi: 10.1007/s00068-020-01461-7. Epub 2020 Aug 14.
BACKGROUND
The utilization and impact of various ratios of transfusions for pediatric trauma patients (PTPs) receiving a massive transfusion (MT) are unknown. Therefore, we sought to determine the risk for mortality in PTPs receiving an MT of ≥ 6 units of packed red blood cells (PRBC) within 24 h. We compared PRBC: plasma ratio of > 2:1 (Unbalanced Ratios, UR) versus ≤ 2:1 (Balanced Ratios, BR), hypothesizing decreased risk of mortality with BR.
METHODS
The Trauma Quality Improvement Program was queried (2014-2016) for PTPs receiving a MT. A multivariable logistic regression model was used to determine risk of mortality.
RESULTS
From 239 PTPs receiving an MT, 98 (41%) received an UR, whereas 141 (59%) received a BR. The median ratios, respectively, were 2.7:1 and 1.2:1. Compared to BR patients, UR patients had no differences in injury severity score (ISS), hypotension on admission, and intensive care unit stay (all p > 0.05). The mortality rates for BR and UR were similar (46.1% vs. 52.0%, p = 0.366). Controlling for age, ISS, and severe head injury, UR demonstrated similar risk of mortality compared to BR (p = 0.276). Additionally, ≥ 4:1 ratio versus ≤ 2:1 showed no difference in associated risk of mortality (p = 0.489).
CONCLUSION
In contrast to adult studies, this study demonstrated that MT ratios of > 2:1 and even ≥ 4:1 were associated with similar mortality compared to BR for PTPs. These results suggest pediatric MT resuscitation may not require strict BR as has been shown beneficial in adult trauma patients. Future prospective studies are needed to evaluate the optimal ratio for PTP MT resuscitation.
LEVEL OF EVIDENCE
III; Retrospective Care Management Study.
背景
对于接受大量输血（MT）的儿科创伤患者（PTP），输注各种比例的血液制品（包括红细胞和血浆）的利用情况及其影响尚不清楚。因此，我们旨在确定在 24 小时内接受 MT 输注≥6 单位的浓缩红细胞（PRBC）的 PTP 患者的死亡率风险。我们比较了 PRBC：血浆比例>2:1（不平衡比例，UR）与≤2:1（平衡比例，BR），假设 BR 组的死亡率风险降低。
方法
我们对创伤质量改进计划（2014-2016 年）进行了查询，以确定接受 MT 的 PTP。使用多变量逻辑回归模型来确定死亡率风险。
结果
在 239 例接受 MT 的 PTP 中，98 例（41%）接受 UR，而 141 例（59%）接受 BR。中位数比例分别为 2.7:1 和 1.2:1。与 BR 患者相比，UR 患者的损伤严重程度评分（ISS）、入院时低血压和重症监护病房（ICU）入住时间均无差异（均 p>0.05）。BR 和 UR 患者的死亡率相似（46.1% vs. 52.0%，p=0.366）。在校正年龄、ISS 和严重颅脑损伤后，UR 患者的死亡率与 BR 患者相似（p=0.276）。此外，≥4:1 比值与≤2:1 比值在死亡率风险方面无差异（p=0.489）。
结论
与成人研究相反，本研究表明，与 BR 相比，PTP 接受 MT 时，比例>2:1，甚至≥4:1，与死亡率相关，提示儿科 MT 复苏可能不需要严格的 BR，这在成人创伤患者中已显示有益。需要进一步前瞻性研究来评估儿科 MT 复苏的最佳比值。
证据等级
III；回顾性护理管理研究。
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