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【輸血縱覽】低溫創傷患者死亡率和血液制品用量的增加

分類:輸血管理   來源:   日期:2019-04-01 17:12:09

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大約一半的創傷患者都經歷過體溫過低(體溫低于36°C),這會導致凝血功能紊亂和不良的健康結果。由于低溫和血液使用之間的關系尚未被調查,研究人員在實用隨機最佳血小板和血漿比率(PROPPR)試驗中與體溫測量確定了590名創傷患者。590例患者中,399例(67.6%)在到達急救中心后6小時內體溫過低。在最初24小時內輸血的紅細胞單位數平均為8.8個。然而,低溫組患者在最初24小時內使用的紅細胞單位(9.9)明顯多于常溫組(6.3)。此外,低溫患者24小時(調整OR,2.7[95%CI,1.7-4.5];p<0.001)和30天(調整OR,1.8[95%CI,1.3-2.4];p<0.001)的死亡率均顯著高于常溫組(p<0.001)。需要進一步的研究,以更好地了解預防低溫對死亡率、血液使用和器官保存的影響。

原文:About half of all trauma patients experience hypothermia (body temperature less than 36°C), which leads to coagulopathy and poor health outcomes. Since the association between hypothermia and blood use has not be investigated, researchers identified 590 trauma patients enrolled in the Pragmatic Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial with body temperature measurements. Of the 590 patients, 399 (67.6%) experienced hypothermia within 6 hours of arriving at the emergency care center. The mean number of RBC units transfused within the first 24 hours was 8.8. Patients with hypothermia, however, used significantly more RBC units (9.9) compared to patients in the normothermic group (6.3) within the first 24 hours. Furthermore, patients with hypothermia had significantly higher odds of dying compared to normothermic patients both at 24 hours (adjusted OR, 2.7 [95% CI, 1.7-4.5]; p<0.001) and 30 days (adjusted OR, 1.8 [95% CI, 1.3-2.4]; p<0.001). Further research is needed to better understand the effects of preventing hypothermia on mortality, blood use, and organ preservation.

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