成人创伤失血性休克患者输血的时机和输血量：一项基于注册登记的队列研究

Timing and volume of transfusion for adult major trauma patients with hemorrhagic shock: a registry-based cohort study.

作者信息

Mitra Biswadev, Singh Bivekjeet, Mathew Joseph, Stewart Cara, Koolstra Christine, Hendel Simon, Fitzgerald Mark

机构信息

Emergency and Trauma Centre, Alfred Health, Melbourne, Victoria, Australia.

Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia.

出版信息

Trauma Surg Acute Care Open. 2024 Feb 7;9(1):e001248. doi: 10.1136/tsaco-2023-001248. eCollection 2024.

DOI:10.1136/tsaco-2023-001248

PMID:38347897

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10860119/

Abstract

INTRODUCTION

Transfusion of blood components is vital for the resuscitation of injured patients in hemorrhagic shock. Delays in initiating transfusion have been associated with harm, as has excess transfusion. The aim of this study was to evaluate variables associated with hospital mortality, with a focus on the two modifiable risk factors- time to initiate transfusion and volume of blood components-with hospital mortality.

METHODS

This was a registry-based cohort study, including all consecutive adult patients presenting with hemorrhagic shock (systolic blood pressure (SBP) ≤90 mm Hg and transfusion of blood components) to a level 1 adult trauma center during a 5-year period (January 1, 2017-December 31, 2021). Associations with hospital mortality were assessed using multivariable logistic regression analysis, with final models developed using backward elimination.

RESULTS

There were 195 patients included and there were 49 (25.1%) in-hospital deaths. The median time to first transfusion was 10 (IQR 6-16) minutes. Age (adjusted OR (aOR) 1.06; 95% CI: 1.03 to 1.08), initial SBP (aOR 0.96; 95% CI: 0.3 to 0.98), intracranial bleeding or diffuse axonal injury (aOR 2.63; 95% CI: 1.11 to 6.23), and the volume of blood components in the first 4 hours (aOR 1.08; 95% CI: 1.03 to 1.13) were associated with mortality. Time to transfusion was not associated with in-hospital mortality (aOR 0.99; 95% CI: 0.95 to 1.03). Among the 90 patients who underwent urgent transfer to the operating room or angiography suite, the median time to transfer was 2.38 hours (IQR 1.5-3.7). In this subgroup, age (aOR 1.11; 95% CI: 1.05 to 1.18) and volume of blood components (aOR 1.20; 95% CI: 1.08 to 1.34) were associated with mortality.

DISCUSSION

In this setting where times to transfusion are short, further reductions in the time to transfusion are unlikely to improve outcome. In our population, for every unit of blood component transfused, the adjusted odds of death increased by 8%. These findings suggest investigation into strategies to achieve earlier control of hemorrhage.

LEVEL OF EVIDENCE

III.

摘要

引言

输注血液成分对于失血性休克受伤患者的复苏至关重要。输血启动延迟以及过度输血均与不良后果相关。本研究的目的是评估与医院死亡率相关的变量，重点关注两个可改变的风险因素——输血启动时间和血液成分输注量——与医院死亡率的关系。

方法

这是一项基于登记的队列研究，纳入了在5年期间（2017年1月1日至2021年12月31日）连续入住一级成人创伤中心且出现失血性休克（收缩压（SBP）≤90 mmHg且输注血液成分）的所有成年患者。使用多变量逻辑回归分析评估与医院死亡率的关联，并通过向后逐步淘汰法建立最终模型。

结果

共纳入195例患者，其中49例（25.1%）院内死亡。首次输血的中位时间为10（四分位间距6 - 16）分钟。年龄（调整后比值比（aOR）1.06；95%置信区间：1.03至1.08）、初始收缩压（aOR 0.96；95%置信区间：0.3至0.98）、颅内出血或弥漫性轴索损伤（aOR 2.63；95%置信区间：1.11至6.23）以及前4小时内血液成分的输注量（aOR 1.08；95%置信区间：1.03至1.13）与死亡率相关。输血时间与院内死亡率无关（aOR 0.99；95%置信区间：0.95至1.03）。在90例紧急转至手术室或血管造影室的患者中，转院的中位时间为2.38小时（四分位间距1.5 - 3.7）。在这个亚组中，年龄（aOR 1.11；95%置信区间：1.05至1.18）和血液成分输注量（aOR 1.20；95%置信区间：1.08至1.34）与死亡率相关。