Boston Children's Hospital, Division of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA.
Curr Opin Pediatr. 2023 Jun 1;35(3):303-308. doi: 10.1097/MOP.0000000000001233. Epub 2023 Feb 10.
Trauma is the leading cause of death in children over 5 years old. Early mortality is associated with trauma-induced coagulopathy (TIC), with balanced resuscitation potentially mitigating the effects of TIC. We review TIC, balanced resuscitation and the best evidence for crystalloid fluid versus early blood products, massive transfusion protocol (MTP) and the optimal ratio for blood products.
Crystalloid fluids have been associated with adverse events in paediatric trauma patients. However, the best way to implement early blood products remains unclear; MTP has only shown improved time to blood products without clear clinical improvement. The indications to start blood products are also currently under investigation with several scoring systems and clinical indications being studied. Current studies on the blood product ratio suggest a 1 : 1 ratio for plasma:pRBC is likely ideal, but prospective studies are needed to further support its use.
Balanced resuscitation strategies of minimal crystalloid use and early administration of blood products are associated with improved morbidity in paediatric trauma patients but unclear mortality benefit. Current evidence suggests that the utilization of MTPs with 1 : 1 plasma:pRBC ratio may improve morbidity, but more research is needed.
创伤是 5 岁以上儿童死亡的主要原因。早期死亡率与创伤诱导的凝血障碍（TIC）有关，平衡复苏可能减轻 TIC 的影响。我们回顾 TIC、平衡复苏以及晶体液与早期血液制品、大量输血方案（MTP）和血液制品最佳比例的最佳证据。
晶体液与儿科创伤患者的不良事件有关。然而，实施早期血液制品的最佳方法仍不清楚；MTP 仅显示出提高血液制品时间而没有明显的临床改善。目前正在研究启动血液制品的指征，有几个评分系统和临床指征正在研究中。目前关于血液制品比例的研究表明，血浆与红细胞的 1:1 比例可能是理想的，但需要前瞻性研究进一步支持其使用。
使用最小量晶体液和早期给予血液制品的平衡复苏策略与改善儿科创伤患者的发病率有关，但对死亡率的益处尚不清楚。目前的证据表明，使用 MTP 并保持 1:1 的血浆与红细胞比例可能会改善发病率，但需要进一步研究。
