Hooker E A, Miller F B, Hollander J L, Bukowski E M
Department of Emergency Medicine, University of Louisville, KY.
J Emerg Med. 1994 Jul-Aug;12(4):447-51. doi: 10.1016/0736-4679(94)90338-7.
Trauma patients frequently have blood drawn for type and crossmatch. The majority of these units are held for 48 hours and never used for that patient. We conducted a retrospective review and followed with a prospective protocol, attempting to identify a variable that would predict the need for blood transfusion, thus decreasing cost and blood waste. In the 180 patients studied retrospectively, we found that 61% of patients with prehospital hypotension (BP < 100 mm Hg) required transfusion, whereas only 11% of patients without prehospital hypotension required transfusion (P < .0001). We prospectively evaluated prehospital hypotension as a predicator of blood usage in 136 patients. Patients with prehospital systolic blood pressure > or = 100 mm Hg had only a type and screen ordered unless clinical judgment dictated otherwise. Of the 136 patients, 109 had no history of prehospital hypotension, and 81 of these were managed with a type and screen. Only 8 patients without prehospital hypotension received a transfusion, 6 because of operative procedures. No patient received uncrossmatched blood, and there were no complications. Implementation of this protocol decreased our units crossmatched for each unit transfused from 3.8 to 2.8. Prehospital blood pressure is a useful adjunct to clinical judgement in identifying major trauma patients who can be initially managed safely without crossmatching.
创伤患者经常需要抽血进行血型鉴定和交叉配血。这些血液中的大部分被保存48小时，最终却从未输给该患者。我们进行了一项回顾性研究，并随后采用了前瞻性方案，试图确定一个能够预测输血需求的变量，从而降低成本和减少血液浪费。在回顾性研究的180例患者中，我们发现，院前低血压（血压<100 mmHg）的患者中有61%需要输血，而院前无低血压的患者中只有11%需要输血（P<0.0001）。我们前瞻性地评估了院前低血压作为136例患者用血预测指标的情况。院前收缩压≥100 mmHg的患者仅进行血型鉴定和筛查，除非临床判断另有要求。在这136例患者中，109例无前院低血压病史，其中81例进行了血型鉴定和筛查。无前院低血压的患者中只有8例接受了输血，其中6例是因为手术。没有患者接受未交叉配血的血液，也没有出现并发症。实施该方案使我们每输注1单位血液所交叉配血的单位数从3.8降至2.8。院前血压是临床判断的有用辅助手段，可用于识别那些最初无需交叉配血就能安全处理的重大创伤患者。
