合并严重创伤性脑损伤与骨盆骨折患者红细胞输注量增加无关：一项回顾性观察研究。
Concomitant severe traumatic brain injury is not associated with increased red blood cell transfusion volumes in patients with pelvic fractures: A retrospective observational study.
机构信息
Department of Anesthesiology and Emergency Medicine, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, Japan; Department of Radiology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-Ku, Tokyo, Japan.
Department of Traumatology and Critical Care Medicine, National Defense Medical College Hospital, 3-2 Namiki, Tokorozawa, Saitama, Japan.
出版信息
Injury. 2024 Mar;55(3):111296. doi: 10.1016/j.injury.2023.111296. Epub 2023 Dec 25.
INTRODUCTION
Traumatic brain injury (TBI)-associated coagulopathy significantly influences survival outcomes in patients with multiple injuries. Severe TBI can potentially affect systemic hemostasis due to coagulopathy; however, there is limited evidence regarding whether the risk of hemorrhage increases in patients with pelvic fractures complicated with TBI. Therefore, through multivariable analysis, we aimed to examine the association between severe TBI and increased blood transfusion requirements in patients with pelvic fractures.
MATERIALS AND METHODS
This retrospective observational study was conducted at a tertiary care facility in Japan. Patients aged 16 years or older with pelvic fractures who were admitted to our intensive care unit between April 2014 and December 2021 were included in the analysis. The patients were categorized into no to mild and severe TBI groups according to whether the Head Abbreviated Injury Scale (AIS) score was 3 or higher. The primary outcome was the number of red blood cell (RBC) units transfused within 24 h after arrival at the hospital. The primary outcome was analyzed using univariable and multivariable linear regression analyses. The covariates used for the multivariable linear regression analysis were age, sex, antithrombotic therapy, mechanism of injury, Pelvic AIS score, and extravasation on contrast-enhanced computed tomography on admission.
RESULTS
We identified 315 eligible patients (221 and 94 in the no to mild and severe TBI groups, respectively). In the univariable analysis, the RBC transfusion volume within 24 h after arrival was significantly higher in the severe TBI group than in the no to mild TBI group (2.53-unit increase; 95 % confidence interval [CI]: 0.46-4.61). However, in the multivariable analysis, no statistically significant association was detected between severe TBI and the RBC transfusion volume within 24 h after arrival at the hospital (0.87-unit increase; 95 % CI: -1.11-2.85).
CONCLUSIONS
Concomitant severe TBI was not associated with increased RBC transfusion volumes in patients with pelvic fractures on multivariable analysis.
介绍
创伤性脑损伤（TBI）相关的凝血障碍显著影响多发伤患者的生存结局。严重 TBI 可能会因凝血障碍而影响全身止血；然而，关于 TBI 合并骨盆骨折患者是否会增加出血风险的证据有限。因此，通过多变量分析，我们旨在研究严重 TBI 与骨盆骨折患者输血需求增加之间的关系。
材料和方法
本回顾性观察性研究在日本的一家三级医疗机构进行。纳入分析的患者为 2014 年 4 月至 2021 年 12 月期间入住我院重症监护病房的年龄在 16 岁及以上、伴有骨盆骨折的患者。根据头部简明损伤量表（AIS）评分是否为 3 或更高，将患者分为无至轻度 TBI 组和严重 TBI 组。主要结局是入院后 24 小时内输注的红细胞（RBC）单位数。主要结局采用单变量和多变量线性回归分析。多变量线性回归分析的协变量包括年龄、性别、抗血栓治疗、损伤机制、骨盆 AIS 评分和入院时增强 CT 上的外渗。
结果
我们确定了 315 名符合条件的患者（无至轻度 TBI 组 221 名，严重 TBI 组 94 名）。在单变量分析中，严重 TBI 组入院后 24 小时内 RBC 输注量明显高于无至轻度 TBI 组（增加 2.53 单位；95%置信区间 [CI]：0.46-4.61）。然而，在多变量分析中，严重 TBI 与入院后 24 小时内 RBC 输注量之间未发现统计学显著关联（增加 0.87 单位；95%CI：-1.11-2.85）。
结论
多变量分析显示，TBI 合并严重骨盆骨折患者的 RBC 输注量无增加。
Zotero 插件