Takiguchi Toru, Seki Tomohisa, Tagami Takashi, Akagi Yu, Nakae Ryuta, Ito Hiromasa, Kawazoe Yoshimasa, Okada Ichiro, Kim Shiei, Inoue Masaaki, Ohe Kazuhiko, Yokobori Shoji
Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, Japan.
Department of Healthcare Information Management, The University of Tokyo Hospital, Tokyo, Japan.
Sci Rep. 2025 Jul 15;15(1):25519. doi: 10.1038/s41598-025-11338-7.
The optimal transfusion ratios for severe blunt trauma requiring massive transfusion remain unclear. This nationwide retrospective cohort study used data from the Japan Trauma Data Bank (2019-2022) and included patients receiving ≥ 10 units of packed red blood cells (pRBC) within 24 h. The fresh frozen plasma (FFP)-to-pRBC and platelet concentrate (PC)-to-pRBC ratios were categorized as 0-0.5, 0.5-1, 1-1.5, 1.5-2, and > 2. Among 2,849 eligible patients, an FFP-to-pRBC ratio of 1-1.5 was associated with significantly higher in-hospital survival than 0.5-1 (adjusted odds ratio [OR], 1.46; 95% confidence interval [CI], 1.12-1.92; P = 0.006). A PC-to-pRBC ratio of 1.5-2 also showed a trend toward improved survival (1.62; 1.00-2.69; P = 0.053). Patients were categorized into three phenotypes: truncal trauma with shock (70.3%), moderate head and extremity trauma (11.8%), and severe head trauma with consciousness disturbances (17.9%). In the truncal trauma with shock phenotype, FFP-to-pRBC ratios of 1-1.5 (1.56; 1.12-2.20; P = 0.010) and > 2 (2.32; 1.14-5.10; P = 0.027) were associated with improved survival. Higher FFP-to-pRBC and PC-to-pRBC ratios may be associated with improved survival, especially in truncal trauma with shock.
对于需要大量输血的严重钝性创伤，最佳输血比例仍不明确。这项全国性回顾性队列研究使用了日本创伤数据库（2019 - 2022年）的数据，纳入了在24小时内接受≥10单位浓缩红细胞（pRBC）的患者。新鲜冰冻血浆（FFP）与pRBC的比例以及血小板浓缩液（PC）与pRBC的比例分为0 - 0.5、0.5 - 1、1 - 1.5、1.5 - 2和>2。在2849例符合条件的患者中，FFP与pRBC比例为1 - 1.5时，院内生存率显著高于0.5 - 1（调整优势比[OR]为1.46；95%置信区间[CI]为1.12 - 1.92；P = 0.006）。PC与pRBC比例为1.5 - 2时也显示出生存改善的趋势（1.62；1.00 - 2.69；P = 0.053）。患者分为三种表型：伴有休克的躯干创伤（70.3%）、中度头部和四肢创伤（11.8%）以及伴有意识障碍的严重头部创伤（17.9%）。在伴有休克的躯干创伤表型中，FFP与pRBC比例为1 - 1.5（1.56；1.12 - 2.20；P = 0.010）和>2（2.32；1.14 - 5.10；P = 0.027）与生存改善相关。较高的FFP与pRBC以及PC与pRBC比例可能与生存改善相关，尤其是在伴有休克的躯干创伤中。
