全血输注治疗急性出血的系统评价和荟萃分析。
Whole blood transfusion in the treatment of acute hemorrhage, a systematic review and meta-analysis.
机构信息
From the Department of Surgery (R.A.V.D.H., T.W.H.R., B.L.S.B.V.D.B.), Alrijne Medical Center, Leiderdorp; Trauma Research Unit Department of Surgery (R.A.V.D.H., T.W.H.R., O.J.F.V.W., M.H.J.V., R.H.), Erasmus MC, University Medical Center Rotterdam, Rotterdam; Military Blood Bank (F.N.), Defense Healthcare Organization (R.H.), Ministry of Defense, Utrecht; and Department of Surgery (R.H.), Leiden University Medical Center, Leiden, The Netherlands.
出版信息
J Trauma Acute Care Surg. 2023 Aug 1;95(2):256-266. doi: 10.1097/TA.0000000000004000. Epub 2023 May 1.
BACKGROUND
Whole blood (WB) transfusion received renewed interest after recent armed conflicts. The effectiveness as compared with blood component transfusion (BCT) is, however, still topic of debate. Therefore, this study investigated the effect of WB ± BCT as compared with BCT transfusion on survival in trauma patients with acute hemorrhage.
METHODS
Studies published up to January 16, 2023, including patients with traumatic hemorrhage comparing WB ± BCT and BCT were included in meta-analysis. Subanalyses were performed on the effectiveness of WB in the treatment of civilian or military trauma patients, patients with massive hemorrhage and on platelet (PLT)/red blood cell (RBC), plasma/RBC and WB/RBC ratios. Methodological quality of studies was interpreted using the Cochrane risk of bias tool. The study protocol was registered in PROSPERO under number CRD42022296900.
RESULTS
Random effect pooled odds ratio (OR) for 24 hours mortality in civilian and military patients treated with WB as compared with BCT was 0.72 (95% confidence interval [CI], 0.53-0.97). In subanalysis of studies conducted in civilian setting (n = 20), early (4 hours, 6 hours, and emergency department) and 24 hours mortality was lower in WB groups compared with BCT groups (OR, 0.65; 95% CI, 0.44-0.96 and OR, 0.71; 95% CI, 0.52-0.98). No difference in late mortality (28 days, 30 days, in-hospital) was found. In military settings (n = 7), there was no difference in early, 24 hours, or late mortality between groups. The WB groups received significant higher PLT/RBC ( p = 0.030) during early treatment and significant higher PLT/RBC and plasma/RBC ratios during 24 hours of treatment ( p = 0.031 and p = 0.007). The overall risk of bias in the majority of studies was judged as serious due to serious risk on confounding and selection bias, and unclear information regarding cointerventions.
CONCLUSION
Civilian trauma patients with acute traumatic hemorrhage treated with WB ± BCT as compared to BCT had lower odds on early and 24-hour mortality. In addition, WB transfusion resulted in higher PLT/RBC and plasma/RBC ratios.
LEVEL OF EVIDENCE
Systematic Review and Meta-Analysis; Level III.
背景
全血（WB）输血在最近的武装冲突后重新受到关注。然而，与血液成分输血（BCT）相比，其有效性仍然是一个争论的话题。因此，本研究调查了 WB±BCT 输血与 BCT 输血相比对创伤性出血患者生存的影响。
方法
对截至 2023 年 1 月 16 日发表的研究进行了荟萃分析，包括比较 WB±BCT 和 BCT 治疗创伤性出血的患者。在治疗平民或军事创伤患者、大出血患者以及血小板（PLT）/红细胞（RBC）、血浆/RBC 和 WB/RBC 比值方面进行了亚组分析。使用 Cochrane 偏倚风险工具解释研究的方法学质量。该研究方案已在 PROSPERO 中以注册号 CRD42022296900 进行了注册。
结果
与 BCT 相比，接受 WB 治疗的平民和军事患者 24 小时死亡率的随机效应汇总比值比（OR）为 0.72（95%置信区间 [CI]，0.53-0.97）。在以平民为研究对象的亚组分析（n=20）中，与 BCT 组相比，WB 组的早期（4 小时、6 小时和急诊室）和 24 小时死亡率较低（OR，0.65；95%CI，0.44-0.96 和 OR，0.71；95%CI，0.52-0.98）。未发现晚期死亡率（28 天、30 天、住院期间）的差异。在军事环境中（n=7），两组之间的早期、24 小时或晚期死亡率无差异。WB 组在早期治疗时接受了显著更高的 PLT/RBC（p=0.030），在 24 小时治疗时接受了显著更高的 PLT/RBC 和血浆/RBC 比值（p=0.031 和 p=0.007）。由于混杂和选择偏倚的严重风险以及关于联合干预的信息不明确，大多数研究的总体偏倚风险被判断为严重。
结论
与 BCT 相比，接受 WB±BCT 治疗的平民创伤性出血急性创伤患者的早期和 24 小时死亡率较低。此外，WB 输血导致 PLT/RBC 和血浆/RBC 比值升高。
证据水平
系统评价和荟萃分析；等级 III。
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