急性术中出血患者血浆-红细胞、血小板-红细胞输注比率的研究

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急性术中出血患者血浆-红细胞、血小板-红细胞输注比率的研究

翻译：任文鑫  编辑：冯玉蓉  审校：曹莹

背景：急性术中出血患者输注同种异体血制品的比率与临床结局之间的关系尚不明确。

方法：为了更好地明确血制品输注比率，我们对2011年1月1日至2015年12月31日期间在术中1小时内接受3个单位或以上红细胞（RBC）（临界输血阈值）快速输血的所有外科患者（≥18岁）进行了一项单中心观察性队列研究。多变量回归分析用于评估输血后3h、12h和24h血浆-红细胞和血小板-红细胞输注比率与临床预后之间的关系。主要观察指标是住院死亡率，次要观察指标为入住重症监护病房天数和非住院天数。

结果：这项研究纳入2385名患者，其中14.9%的患者血浆-红细胞比率为1.0+，47.6%的患者血小板-红细胞比率为1.0+。研究表明，接受心脏手术、移植手术以及止血化验值异常紊乱的血管手术的患者输注血浆-红细胞和血小板-红细胞比率较高。这一比率不因患者年龄或病情严重程度而不同。较高的输血比率与临床预后改善无关。死亡率与血小板-红细胞输注比率有关，但与血浆-红细胞输注比率无关，与未输注血小板相比，24h观察到血小板-红细胞输注比率为0.1~0.9(优势比 3.34[1.62~6.88])时死亡率最高(P=0.001)。较高的血浆-红细胞输注比率与减少非住院天数有关，尽管排除了不接受成分输血治疗的红细胞输注患者，临床预后的差异仍不显著。

结论：外科手术中严重出血患者的输血率与手术和止血特征密切相关，而与患者的基线特征无关。输血率高与预后改善无关。

文献来源：

Matthew A. Warner, Ryan D. Frank, Timothy J. Weister,et al.Ratios of Plasma and Platelets to Red Blood Cells in Surgical Patients With Acute Intraoperative Hemorrhage.[J].Anesth Analg 2020;131:483–93.

Ratios of Plasma and Platelets to Red Blood Cells in Surgical Patients With Acute Intraoperative Hemorrhage

BACKGROUND: The relationships between the ratios of transfused allogeneic blood productsand clinical outcomes in patients with acute intraoperative hemorrhage are poorly defined.

METHODS: To better define these ratios, we undertook a single-center, observational cohort study of all surgical patients (≥18 years) who received rapid transfusion defined by a critical administration threshold of 3 or more units of red blood cells (RBCs) intraoperatively within 1hour between January 1, 2011 and December 31, 2015. Multivariable regression analyses were used to assess relationships between ratios of plasma to RBCs and platelets to RBCs at 3, 12,and 24 hours and clinical outcomes. The primary outcome was hospital mortality, with secondary outcomes of intensive care unit and hospital-free days.

RESULTS: The study included 2385 patients, of whom 14.9% had a plasma-to-RBC ratio of 1.0+, and 47.6% had a platelet-to-RBC ratio of 1.0+. Higher plasma-to-RBC and platelet-to-RBC ratios were observed for patients who underwent cardiac, transplant, and vascular surgeryand in patients with greater derangements in hemostatic laboratory values. Ratios did not differ by patient age or severity of illness. Higher ratios were not associated with improved clinical outcomes. Mortality differed by platelet-to-RBC but not plasma-to-RBC ratio, with the highest mortality observed with a platelet-to-RBC ratio of 0.1–0.9 at 24 hours (odds ratio, 3.34[1.62–6.88]) versus no platelets (P = .001). Higher plasma-to-RBC ratios were associated with decreased hospital-free days, although differences in clinical outcomes were not significant after exclusion of patients receiving only RBCs without component therapies.

CONCLUSIONS: Transfusion ratios in surgical patients with critical intraoperative hemorrhage were largely related to surgical and hemostatic features rather than baseline patient characteristics.Higher ratios were not associated with improved outcomes.

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