血液成分的输血比例对大量输血患者死亡率影响

辛峰; 高海燕; 孔燕; 马现君

doi:10.13201/j.issn.1004-2806-b.2017.10.026

血液成分的输血比例对大量输血患者死亡率影响

- 山东大学齐鲁医院输血科(济南, 250012)
基金项目:
济南市高校院所自主创新项目(No:201102068)

详细信息

通讯作者: 马现君,E-mail:mxj1971612@126.com

中图分类号: R457.1

收稿日期: 2017-04-26

Study of influence of transfusion ratios of blood components on mortality of patients with massive transfusion

More Information

Corresponding author: MA Xian-jun, E-mail: mxj1971612@126.com

Received Date: 26 April 2017

摘要

- 大量输血 /
- 输血比例 /
- 死亡率
Abstract: Massive transfusion is defined as the equal volume of transfusion to that of the loss of one within a 24 hours period or defined as receiving 10 or more units of red blood cells in 24 hours.However,this definition was full of controversy because of failing to eliminate survival bias.Other definitions have been put forward to improve it such as transfusion of the volume of 5 or more units of red blood cells in 4 hours or the rate of transfusion of 4 or more units of red blood cells per hour.Alternatively CAT,which was defined by receiving 3 or more units of red blood cells within any 1-hour time frame during the first 24 hours after injury,was raised to eliminate survival bias to some extent.Researchers have proposed the concept of Resuscitation Intensity,which was consisted of all fluids used for the initial resuscitation of a patient,not only red blood cells,plasma and platelets but also crystalloid,colloid,by carrying out the study of PROMMTT.As a result,the concept of Resuscitation Intensity is objective relatively to assess the severity of patients with massive loss of blood.The ratios of transfusion were concluded as 1:1 for plasma relative to red blood cells as well as 1:1:1 for plasma,platelets relative to red blood cells home mostly.And for abroad it was still inconclusive of how patients benefiting from high ratios of transfusion of plasma relative to red blood cells or high ratios of transfusion of plasma,platelets relative to red blood cells.Therefore further researches ought to be carried out to clarify the relationship between the ratios of transfusion and its influence in the mortality of patients with massive transfusion.
- massive transfusion /
- ratios of transfusion /
- mortality

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参考文献(36)

[1]	任秀慧.大量输血及其并发症的探讨[J].中国实用医药,2015,10(1):27-28.
[2]	王伟,赵海涛,胡旭梅,等.预防性早期输注新鲜冰冻血浆对大量输血患者凝血功能的影响[J].临床血液学杂志:输血与检验,2016,29(5):816-818.
[3]	卢春生,林列坤,曹文平,等.大量输血引起的血清电解质及凝血功能变化的研究[J].检验医学与临床,2013,10(3):291-292.
[4]	Kim Y,Lee K,Kim J,et al.Application of damage control resuscitation strategies to patients with severe traumatic hemorrhage:review of plasma to packed red blood cell ratios at a single institution[J].Critical Care,2014,29:1007-1011.
[5]	Thibeault S.Massive Transfusion for Hemorrhagic Shock:What Every Critical Care Nurse Needs to Know[J].Crit Care NursClin North Am,2015,27:47-53.
[6]	Jr SM,Kalata S,Liveris A,et al.End-tidal CO₂ on admission is associated with hemorr hagic shock and predicts the need for massive transfusion as defined by the critical administration threshold:A pilot study[J].Injury-international Journal of the Care of the Injured,2017,48:51-57.
[7]	Davis WB,Eaton M.Massive Transfusion and Complications[M].Springer Berlin Heidelberg,2015.
[8]	Oldroyd JC,Venardos KM,Aoki NJ,et al.Improving outcomes for hospital patients with critical bleeding requiring massive transfusion:the Australian and New Zealand Massive Transfusion Registry study methodology[J].Bmc Research Notes,2016,9:1-10.
[9]	Zatta AJ,Mcquilten ZK,Mitra B,et al.Elucidating the clinical characteristics of patients captured using different definitions of massive transfusion[J].VoxSanguinis,2014,107:60-70.
[10]	Simms ER,Hennings DL,Hauch A,et al.Impact of Infusion Rates of Fresh Frozen Plasma and Platelets During the First 180 Minutes of Resuscitation[J].Journal of the American College of Surgeons,2014,219:181-188.
[11]	Moren AM,Hamptom D,Diggs B,et al.Recursive Partitioning Identifies Greater Than 4units of PRBC's Per Hour as an Improved Massive Transfusion Definition[J].J Trauma Acute Care Surg,2015,79:920-924.
[12]	Rahbar E,Fox EE,del Junco DJ,et al.Early resuscitation intensity as a surrogate for bleeding severity and early mortality in the PROMMTT study[J].JTrauma Acute Care Surg,2013,75:S16-23.
[13]	Savage SA,Zarzaur BL,Croce MA,et al.Redefining massive transfusion when every second counts[J].JTrauma Acute Care Surg,2013,74:396-402.
[14]	Shroyer MC,Griffin RL,Mortellaro VE,et al.Massive transfusion in pediatric trauma:analysis of the National Trauma Databank[J].J Surg Res,2016,208:166-172.
[15]	Neff LP,Cannon JW,Morrison JJ,et al.Clearly defining pediatric massive transfusion:Cutting through the fog and friction with combat data.[J].J Trauma Acute Care Surg,2015,78:22-29.
[16]	虞芳,钟涛,武钢.输注高/低比例血浆及红细胞对创伤后需大量输血救治患者疗效的meta分析[J].南方医科大学学报,2017,37(1):119-123.
[17]	文贤慧,刘凤霞,张军华,等.大量输血时血浆与红细胞的比例探讨[J].中国实验血液学杂志,2014,22(3):825-828.
[18]	陈淑芬.不同比例血浆和浓缩红细胞输注对产后大出血患者的效果观察[J].中国卫生标准管理,2015,6(30):177-178.
[19]	刘桂芳,金勇,夏和凤.产后出血患者大量输血治疗时血浆和红细胞的比例对凝血功能的影响[J].江苏医药,2016,42(14):1579-1581.
[20]	崔锐红,李俊杰,陈实,等.等比例成分输血治疗多发伤并发创伤性凝血病疗效研究[J].临床急诊杂志,2015(12):912-916.
[21]	张广暖.不同比例血浆和红细胞对创伤性失血患者救治的影响研究[J].中国卫生标准管理,2015,6(32):199-200.
[22]	项嘉亮,黄伟刚,陈炎添.输注不同比例的血浆、冷沉淀、红细胞对大量输血患者凝血功能的影响[J].中国医学工程,2015,14(5):86-87.
[23]	Delaney M,Stark PC,Suh M,et al.Massive Transfusion in Cardiac Surgery:The Impact of Blood Component Ratios on Clinical Outcomes and Survival[J].Anesth Analg,2017,124:1777-1782.
[24]	Mesar T,Larentzakis A,Dzik W,et al.Association Between Ratio of Fresh Frozen Plasma to Red Blood Cells During Massive Transfusion and Survival A-mong Patients Without Traumatic Injury[J].AMASurg,2017,152:574-580.
[25]	Teixeira PG,Inaba K,Karamanos E,et al.The survival impact of plasma to red blood cell ratio in massively transfused non-trauma patients[J].Eur J Trauma Emerg Surg,2017,43:393-398.
[26]	Peralta R,Vijay A,El-Menyar A,et al.Early high ratio platelet transfusion in trauma resuscitation and its outcomes[J].Int J Crit Illn Inj Sci,2016,6:188-193.
[27]	Peralta R,Vijay A,El-Menyar A,et al.Trauma resuscitation requiring massive transfusion:a descriptive analysis of the role of ratio and time[J].World JEmerg Surg,2015,10:36.
[28]	Mazzeffi MA,Chriss E,Davis K,et al.Optimal Plasma Transfusion in Patients undergoing Cardiac Operations With Massive Transfusion[J].Ann Thorac Surg,2017,104:153-160.
[29]	Holcomb JB,Tilley BC,Baraniuk S,et al.Transfusion of plasma,platelets,and red blood cells in a 1:1:1vs a 1:1:2ratio and mortality in patients with severe trauma:the PROPPR randomized clinical trial[J].JAMA,2015,313:471-482.
[30]	Montan C,Hammar U,Wikman A,et al.Massive Blood Transfusion in Patients with Ruptured Abdominal Aortic Aneurysm[J].Eur J Vasc Endovasc Surg,2016,52:597-603.
[31]	Jones AR,Frazier SK.Association of Blood Component Ratio With Clinical Outcomes in Patients After Trauma and Massive Transfusion:A Systematic Review[J].Adv Emerg Nurs J,2016,38:157-168.
[32]	Kudo D,Sasaki J,Akaishi S,et al.Efficacy of a high FFP:PRBC transfusion ratio on the survival of severely injured patients:a retrospective study in a single tertiary emergency center in Japan[J].Surgery Today,2014,44:653-661.
[33]	Palmieri TL,Greenhalgh DG,Sen S.Prospective comparison of packed red blood cell-to-fresh frozen plasma transfusion ratio of 4:1versus 1:1during acute massive burn excision[J].J Trauma Acute Care Surg,2013,74:76-83.
[34]	Rankin D,Zuleta-Alarcon A,Soghomonyan S,et al.Massive blood loss in elective spinal and orthopedic surgery:Retrospective review of intraoperative transfusion strategy[J].J Clin Anesth,2017,37:69-73.
[35]	Murphy CH,Hess JR.Massive transfusion:red blood cell to plasma and platelet unit ratios for resuscitation of massive hemorrhage[J].Curr Opin Hematol,2015,22:533-539.
[36]	Gregory JA,Huitron SS,George AA,et al.Optimizing Transfusion Ratios in Massive Transfusion Protocols:An Argument Against the 1:1:1 Dogma and Approach to Trauma Resuscitation[J].Laboratory Medicine,2015,46:e46-e52.