Department of Anesthesiology, Pain Medicine, and Perioperative Medicine, Henry Ford Health System, Detroit, Michigan, USA.
Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois, USA.
Transfusion. 2024 Nov;64(11):2104-2113. doi: 10.1111/trf.18029. Epub 2024 Oct 1.
Massive transfusion with citrated blood products causes hypocalcemia, which is associated with mortality. Recognition of this problem has led to increased calcium administration; however, the optimal dosing is still unknown.
This retrospective, single-center study included level 1 trauma patients in 2019 and 2020 who underwent an operation within 12 h of arrival and received a transfusion. Preoperative and intraoperative administrations were totaled to calculate the ratio of administered calcium to the number of blood transfusions for each patient. The citrate content of each blood component was estimated to calculate a second ratio, the ratio of administered calcium to administered citrate. Receiver Operating Characteristic (ROC) curves were performed on both ratios to determine the optimal cutoff values for predicting severe hypocalcemia (ionized calcium <0.9 mmol/L) and hypercalcemia (>1.35 mmol/L) at the end of the intraoperative period.
A total of 506 trauma activations were included, receiving a mean of 17.4 citrated blood products and 16.3 mmol of calcium (equivalent to 2400 mg of calcium chloride). No ratio was statistically significant in differentiating severely hypocalcemic patients from the rest. A calcium to blood ratio of 0.903 mmol of administered calcium per citrated blood product differentiated hypercalcemic patients from the rest.
Quantifying received calcium and citrated blood products was insufficient to predict severe hypocalcemia, suggesting other contributions to hypocalcemia. We demonstrated an upper-limit ratio for calcium administration in traumatic hemorrhage; however, further studies are required to determine what calcium dosing regimen results in the best outcomes.
大量输注柠檬酸盐血液制品会导致低钙血症，与死亡率相关。对这一问题的认识导致了钙的补充增加；然而，最佳剂量仍不清楚。
本回顾性单中心研究纳入了 2019 年和 2020 年 1 级创伤患者，这些患者在到达后 12 小时内接受了手术，并接受了输血。将术前和术中的给药量相加，计算每位患者的钙给药量与输血量的比值。估计每个血液成分中的柠檬酸盐含量，计算第二个比值，即钙给药量与钙给药量的比值。对两个比值进行受试者工作特征 (ROC) 曲线分析，以确定预测术中期末严重低钙血症（离子钙<0.9mmol/L）和高钙血症（>1.35mmol/L）的最佳截断值。
共纳入 506 例创伤激活，平均接受 17.4 份柠檬酸盐血液制品和 16.3mmol 钙（相当于 2400mg 氯化钙）。没有一个比值在区分严重低钙血症患者与其他患者方面具有统计学意义。钙与血制品的比值为 0.903mmol 给予的钙与每单位柠檬酸盐血制品可区分高钙血症患者与其他患者。
定量接受的钙和柠檬酸盐血液制品不足以预测严重低钙血症，表明低钙血症还有其他原因。我们证明了创伤性出血中钙给药的上限比值；然而，需要进一步研究确定哪种钙剂量方案会产生最佳结果。
