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大量输血和严重低钙血症:监测和补充指南的机会。

Massive transfusions and severe hypocalcemia: An opportunity for monitoring and supplementation guidelines.

机构信息

Division of Trauma and Acute Care Surgery, Oregon Health & Science University, Portland, Oregon, USA.

Operative Care Division, Portland VA Medical Center, Portland, Oregon, USA.

出版信息

Transfusion. 2021 Jul;61 Suppl 1:S188-S194. doi: 10.1111/trf.16496.

Abstract

BACKGROUND

Massive transfusion protocols (MTPs) are associated with severe hypocalcemia, contributing to coagulopathy and mortality in severely injured patients. Severity of hypocalcemia following massive transfusion activation and appropriate treatment strategies remain undefined.

STUDY DESIGN AND METHODS

This was a retrospective study of all MTP activations in adult trauma patients at a Level 1 trauma center between August 2016 and September 2017. Units of blood products transfused, ionized calcium levels, and amount of calcium supplementation administered were recorded. Primary outcomes were ionized calcium levels and the incidence of severe ionized hypocalcemia (iCa ≤1.0 mmol/L) in relation to the volume of blood products transfused.

RESULTS

Seventy-one patients had an MTP activated during the study period. The median amount of packed red blood cells (PRBCs) transfused was 10 units (range 1-52). A total of 42 (59.1%) patients had periods of severe hypocalcemia. Patients receiving 13 or more units of PRBC had a greater prevalence of hypocalcemia with 83.3% having at least one measured ionized calcium ≤1.0 mmoL/L (p = .001). The number of ionized calcium levels checked and the amount of supplemental calcium given in patients who experienced hypocalcemia varied considerably.

DISCUSSION

Severe hypocalcemia commonly occurs during MTP activations and correlates with the number of packed red blood cells transfused. Monitoring of ionized calcium and amount of calcium supplementation administered is widely variable. Standardized protocols for recognition and management of severe hypocalcemia during massive transfusions may improve outcomes.

摘要

背景

大量输血方案(MTP)与严重低钙血症有关,这会导致严重创伤患者的凝血功能障碍和死亡率升高。大量输血激活后低钙血症的严重程度和适当的治疗策略仍未确定。

研究设计与方法

这是 2016 年 8 月至 2017 年 9 月期间,在一家 1 级创伤中心对所有成年创伤患者的 MTP 激活情况进行的回顾性研究。记录了输注的血液制品单位、离子钙水平和给予的钙补充量。主要结局是离子钙水平和与输血量相关的严重离子低钙血症(iCa ≤1.0mmol/L)的发生率。

结果

在研究期间,有 71 名患者的 MTP 被激活。输注的浓缩红细胞(PRBC)中位数为 10 单位(范围 1-52)。共有 42 名(59.1%)患者出现严重低钙血症。输注 13 个或更多单位 PRBC 的患者低钙血症发生率更高,有 83.3%的患者至少有一次测得的离子钙≤1.0mmol/L(p=0.001)。在出现低钙血症的患者中,检查离子钙的次数和给予的钙补充量差异很大。

讨论

大量输血激活期间常发生严重低钙血症,且与输注的浓缩红细胞数量相关。离子钙监测和给予的钙补充量差异很大。在大量输血期间严重低钙血症的识别和管理方面的标准化方案可能会改善结果。

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