不同配比输血方案治疗严重创伤出血的疗效分析

doi:10.3969/j.issn.1002-1949.2017.10.008

Chinese Journal of Critical Care Medicine

2017, Vol. 37

Issue (10): 907-911 DOI: 10.3969/j.issn.1002-1949.2017.10.008

Comparison of different plasma to packed red blood cell ratios in patients with severe traumatic hemorrhage

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Abstract Objective: To compare the efficacy and safety of different plasma to packed red blood cell ratios in resuscitating patients with severe traumatic hemorrhage. Methods: We retrospectively reviewed the medical records of 150 traumatic patients treated with massive transfusions from October 2011 to October 2015. Patients were divided into 3 groups according to the fresh frozen plasma(FFP): packed red blood cell(PRBC)ratio: a low-ratio(FFP/PRBC≤1∶2, 51 cases), a mediate group(1∶2＜FFP/PRBC≤1∶1, 49 cases)and a high-ratio group(FFP/PRBC＞1∶1, 50 cases). The patient demographics, fluid and transfusion quantities, laboratory values, complications, and outcomes were analyzed and compared. Results: During the first 24 hours, FFP quantities and FFP/PRBC ratios between any two groups were significantly different. To maintain the blood volume, the low-ratio group who were given less FFP, however, required more crystalloids which resulted in a poorer 24h laboratory values. Infections and transfusion related acute lung injuries were more common in the high-ratio group, and the difference was statistically significant. Kaplan-Meier plots revealed that the 24h survival rate was significantly higher in the mediate-ratio group(81.6%)and the high-ratio group(82.0%)than the low-ratio group(60.8%)(P＜0.001). However, the 30d survival rate in the high-ratio group sharply decreased to 62.0%, which was not significantly different from the low-ratio group(51.0%, P=0.264). There was still a significant difference in the 30d survival rate between the mediate and low-ratio group(75.5% vs. 51.0%, P=0.011). Conclusion: In severe hemorrhagic traumatic patients, as the FFP/PRBC ratio increases, the 24 h laboratory values are improved and the short-term survival rates(24 h)increased. However, the risk of transfusion-related complication increases significantly when the FFP/PRBC ratio is raised to ＞1∶1. So, 1∶2＜FFP/PRBC≤1∶1 may be an optimal transfusion choice for severe traumatic hemorrhage.

Received: 26 February 2017

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http://www.cnemergency.org.cn/EN/10.3969/j.issn.1002-1949.2017.10.008 OR http://www.cnemergency.org.cn/EN/Y2017/V37/I10/907

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