平衡止血复苏治疗出血性儿科创伤患者：全国范围的结局定量分析。

Balanced hemostatic resuscitation for bleeding pediatric trauma patients: A nationwide quantitative analysis of outcomes.

机构信息

Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, 1501 N. Campbell Ave, Room 5411, P.O. Box 245063, Tucson, AZ 85724, USA.

出版信息

J Pediatr Surg. 2022 Dec;57(12):986-993. doi: 10.1016/j.jpedsurg.2022.07.005. Epub 2022 Jul 15.

DOI:10.1016/j.jpedsurg.2022.07.005

PMID:35940936

Abstract

BACKGROUND

The administration of balanced component therapy has been associated with improvements in outcomes in adult trauma. There is little to no specific data to guide transfusion ratios in children. The aim of our study is to compare outcomes among different transfusion strategies in pediatric trauma patients.

METHODS

We conducted a (2014-2016) retrospective analysis of the Trauma Quality Improvement Program. We selected all pediatric (age < 18) trauma patients who received at least one unit of packed red blood cells (PRBC) and fresh frozen plasma (FFP) within 4 h of admission. Patients were stratified based on their FFP:PRBC transfusion ratio in the first 4 h into: 1:1, 1:2, 1:3, and 1:3+. Primary outcomes were 24-mortality, in-hospital mortality. Secondary outcomes were complications and 24 h PRBC transfusion requirements. Multivariable logistic regression analysis was performed.

RESULTS

A total of 1,233 patients were identified of which 637 received transfusion ratio of 1:1, 365 1:2, 116 1:3, and 115 1:3+. Mean age was 11 ± 6y, 70% were male, ISS was 27 [20-38], and 62% sustained penetrating injuries. Patients in the 1:1 group had the lowest 24 h mortality (14% vs. 18% vs. 22% vs. 24%; p = 0.01) and in-hospital mortality (32% vs. 36% vs. 40% vs. 44%; p = 0.01). No difference was found between the groups in terms of complications (22% vs. 21% vs. 23% vs. 22%; p = 0.96) such as acute respiratory distress syndrome (3.3% vs. 3.6% vs. 0.9% vs. 0%; p = 0.10), and acute kidney injury (3% vs. 2.2% vs. 0.9% vs. 0.9%; p = 0.46). Additionally the 1:1 group had the lowest PRBC transfusion requirements (3[2-7] vs. 5[2-10] vs. 6[3-8] vs. 6[4-10]; p < 0.01). On regression analysis a progressive increase in the mortality adjusted odds ratio was observed as the FFP:PRBC transfusion ratio decreased.

CONCLUSION

FFP:PRBC ratios closest to 1 were associated with increased survival in children. The resuscitation of pediatric patients should target a 1:1 ratio of FFP:PRBC. Further studies are needed for the development of massive transfusion protocols for this age group.

LEVEL OF EVIDENCE

Level IV STUDY TYPE: Therapeutic/Care Management.

摘要

背景

平衡成分治疗的管理与成人创伤结局的改善有关。在儿童中，几乎没有具体的数据可以指导输血比例。我们的研究旨在比较儿科创伤患者不同输血策略的结果。

方法

我们对创伤质量改进计划（2014-2016 年）进行了回顾性分析。我们选择了所有在入院后 4 小时内至少接受了 1 个单位的浓缩红细胞（PRBC）和新鲜冷冻血浆（FFP）的儿科（年龄 < 18 岁）创伤患者。根据他们在头 4 小时内的 FFP:PRBC 输血比例将患者分层：1:1、1:2、1:3 和 1:3+。主要结局为 24 小时死亡率和院内死亡率。次要结局为并发症和 24 小时 PRBC 输血需求。进行多变量逻辑回归分析。

结果

共确定了 1233 例患者，其中 637 例接受了 1:1 的输血比例，365 例接受了 1:2 的输血比例，116 例接受了 1:3 的输血比例，115 例接受了 1:3+的输血比例。平均年龄为 11±6 岁，70%为男性，ISS 为 27[20-38]，62%的患者发生穿透性损伤。1:1 组的 24 小时死亡率（14%比 18%比 22%比 24%；p=0.01）和院内死亡率（32%比 36%比 40%比 44%；p=0.01）最低。各组之间的并发症（22%比 21%比 23%比 22%；p=0.96）没有差异，如急性呼吸窘迫综合征（3.3%比 3.6%比 0.9%比 0%；p=0.10）和急性肾损伤（3%比 2.2%比 0.9%比 0.9%；p=0.46）。此外，1:1 组的 PRBC 输血需求最低（3[2-7]比 5[2-10]比 6[3-8]比 6[4-10]；p<0.01）。在回归分析中，随着 FFP:PRBC 输血比例的降低，死亡调整优势比逐渐增加。