摘要
目的采用meta分析的方法评估高/低比例(≥1∶2/<1∶2)输注血浆及红细胞对创伤后需大量输血救治患者的疗效。方法系统性检索Cochrane Library、Pubmed、Web of science、EMBASE,时间为2009年1月~2016年4月。由2名研究者独立进行文献筛选、质量评价和资料提取,采用Revman5.3进行统计分析。观察指标包括患者24 h及30 d死亡率、24 h生存率。结果纳入5篇文献,共计1024例患者,两组创伤严重程度评分无统计学差异。结果显示,高比例组患者24 h死亡率明显降低(OR0.35,95%CI[0.25,0.48],P<0.000 01);高比例组患者30 d死亡率仍明显低于低比例组(OR0.55,95%CI[0.41,0.75],P=0.0001);高比例组患者24 h生存率也显著提高(HR2.34,95%CI[1.46,3.73],P=0.000 01)。结论输注高比例血浆及红细胞可显著降低创伤后需要大量输血救治患者短期和长期死亡率,提高患者短期生存率。
Objective To evaluate the efficacy of high （≥1∶2） and low （〈1∶2） plasma：red blood cell （RBC） ratio resuscitation in patients with severe trauma requiring massive blood transfusion. Methods The databases including the Cochrane Library, Pubmed, Web of Science, and EMBASE were systemically searched for relevant studies published between January, 2009 and April, 2016. The selection of studies, assessment of methodological quality and data extraction were performed by two researchers independently according to the inclusion and exclusion criteria. The main endpoint was 24-h mortality, 30-day mortality and 24-h survival rate. Results Five observational studies reporting outcomes of 1024 patients were included in this meta-analysis. Four studies documented civilian cases and one study had a military setting. No significant differences were found in the Injury Severity Score （ISS） between patient groups receiving high and low plasma： RBC ratio resuscitation. Compared with the low-ratio group, the patients with high-ratio resuscitation showed a significant reduction in the 24-h mortality rate （OR=0.35, 95%CI [0.25, 0.48], P〈0.00001） and the 30-day mortality rate （OR=0.55, 95%CI [0.41, 0.75], P=0.0001）. An increased survival rate was observed in patients receiving high plasma：RBC ratio resuscitation within the initial 24 h following the trauma （HR=2.34, 95%CI [1.46, 3.73], P=0.00001）. Conclusion Raising the plasma：RBC ratio to 0.5 or higher may decrease the mortality rate of the patients with severe trauma who need massive blood transfusion.
出处
《南方医科大学学报》
CAS
CSCD
北大核心
2017年第1期119-123,共5页
Journal of Southern Medical University
基金
广东省科技计划项目(2014A020212192)
关键词
创伤
大量输血
血浆
META分析
创伤性凝血病
trauma
massive blood transfusion
plasma-red blood cell ratio
meta-analysis
trauma-induced coagulopathy
