研究初始输注血浆与红细胞比例较高的血液制品与创伤后严重出血成人死亡率之间的关联。

Investigating the association between initial blood product transfusion with a higher plasma-to-red blood cell ratio and mortality in adults with severe bleeding following trauma.

作者信息

Farahani Parham Khoshdani, Shahmoradi Mohammad Kazem, Sharifian Masoud, Pak Haleh

机构信息

Department of Surgery, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran.

Department of General Surgery, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran.

出版信息

Ann Med Surg (Lond). 2025 Apr 22;87(6):3183-3188. doi: 10.1097/MS9.0000000000003314. eCollection 2025 Jun.

DOI:10.1097/MS9.0000000000003314

PMID:40486573

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12140757/

Abstract

OBJECTIVE

Trauma patients presenting with massive bleeding require significant blood transfusions to restore circulation and achieve hemostasis. The ratio of fresh-frozen plasma (FFP) to packed red blood cells (PRBC) is critical in determining immediate outcomes and mortality in these patients. This study aims to evaluate the impact of a high FFP:PRBC ratio on 24-hour and 30-day mortality among trauma patients with massive bleeding.

METHODS

In this retrospective descriptive study, inclusion criteria involved adults aged 18 or older presenting with massive trauma-related bleeding within 6 hours after trauma. Patients were categorized into two groups based on the FFP:PRBC ratio: high ratio (>1:1.5) or low ratio (<1:1.5) for damage control resuscitation. Data on demographic characteristics, mortality, intensive care unit (ICU) admission, length of hospital stay, and need for mechanical ventilation were collected. The primary outcomes were 24-hour and 30-day mortality, while secondary outcomes included ICU admission, mechanical ventilation duration, and hospital stay length. A Chi-square test was used to evaluate the association betweena high FFP:PRBC ratio and 24-hour and 30-day mortality. The Mann-Whitney test was used to analyze secondary outcomes.

RESULTS

Among 300 patients with a mean age of 40.5 years, 231 (76.7%) were male, and 69 (22.9%) were female. The high FFP:PRBC ratio group showed significantly higher rates of 24-hour mortality (11.5%), 30-day mortality (45.9%), and ICU admission ( < 0.001). However, the mean duration of mechanical ventilation in the high ratio group was 3.36 ± 2.85 days, indicating that some patients in this group still required ventilatory support.

CONCLUSION

This study demonstrates that a high FFP:PRBC ratio (>1:1.5) is associated with reduced 24-hour and 30-day mortality rates among trauma patients with massive hemorrhage. However, the need for mechanical ventilation in some high-ratio patients suggests potential trade-offs that warrant further investigation. Additional research is needed to explore the potential adverse effects of high FFP:PRBC ratios and to optimize transfusion strategies in trauma care.

摘要

目的

出现大量出血的创伤患者需要大量输血以恢复循环并实现止血。新鲜冰冻血浆（FFP）与浓缩红细胞（PRBC）的比例对于确定这些患者的即刻预后和死亡率至关重要。本研究旨在评估高FFP:PRBC比例对大量出血的创伤患者24小时和30天死亡率的影响。

方法

在这项回顾性描述性研究中，纳入标准包括18岁及以上的成年人，在创伤后6小时内出现与创伤相关的大量出血。根据FFP:PRBC比例将患者分为两组：用于损伤控制复苏的高比例组（>1:1.5）或低比例组（<1:1.5）。收集有关人口统计学特征、死亡率、重症监护病房（ICU）入住情况、住院时间和机械通气需求的数据。主要结局为24小时和30天死亡率，次要结局包括ICU入住情况、机械通气持续时间和住院时间。采用卡方检验评估高FFP:PRBC比例与24小时和30天死亡率之间的关联。采用曼-惠特尼检验分析次要结局。

结果

在300例平均年龄为40.5岁的患者中，231例（76.7%）为男性，69例（22.9%）为女性。高FFP:PRBC比例组的24小时死亡率（11.5%）、30天死亡率（45.9%）和ICU入住率显著更高（<0.001）。然而，高比例组的平均机械通气时间为3.36±2.85天，表明该组中的一些患者仍需要通气支持。