Abstract：
BACKGROUND: Calcium is required for coagulation, cardiac output, and peripheral vascular resistance. Between 85% and 94% of trauma patients treated with massive blood transfusion develop hypocalcemia.1 The aim of this study is to evaluate the relationship between increased intravenous calcium administration during massive transfusion and improved survival of trauma patients.
METHODS: We performed a retrospective analysis of trauma patients who received massive transfusion over a 2-y period. Doses of elemental calcium administered per unit of blood product transfused were calculated by calcium to blood product ratio (CBR). Chi-square test evaluated association between coagulopathy and 30-d mortality. Two-sample t-test evaluated association between CBR and coagulopathy. Bivariate regression analysis evaluated association between CBR and blood products transfused per patient. Multivariable logistic regression analysis, controlling for age, sex, coagulopathy, and Injury Severity Score evaluated the association between CBR and mortality.
RESULTS: The study included 77 patients. Coagulopathy was associated with increased 30-d mortality (P < 0.05). Patients who survived had higher CBR than those who died (P < 0.05). CBR was associated with a significant reduction in total blood products transfused per patient (P < 0.05). CBR was not associated with coagulopathy (P = 0.24). Multivariable logistic regression analysis demonstrated that Injury Severity Score ≥16, coagulopathy and decreased CBR were significant predictors of mortality (P < 0.05). CBR above 50 mg was a predictor of survival (P < 0.05).
CONCLUSIONS: Higher doses of calcium given per blood product transfused were associated with improved 30-d survival and decreased blood product transfusions.
METHODS: We performed a retrospective analysis of trauma patients who received massive transfusion over a 2-y period. Doses of elemental calcium administered per unit of blood product transfused were calculated by calcium to blood product ratio (CBR). Chi-square test evaluated association between coagulopathy and 30-d mortality. Two-sample t-test evaluated association between CBR and coagulopathy. Bivariate regression analysis evaluated association between CBR and blood products transfused per patient. Multivariable logistic regression analysis, controlling for age, sex, coagulopathy, and Injury Severity Score evaluated the association between CBR and mortality.
RESULTS: The study included 77 patients. Coagulopathy was associated with increased 30-d mortality (P < 0.05). Patients who survived had higher CBR than those who died (P < 0.05). CBR was associated with a significant reduction in total blood products transfused per patient (P < 0.05). CBR was not associated with coagulopathy (P = 0.24). Multivariable logistic regression analysis demonstrated that Injury Severity Score ≥16, coagulopathy and decreased CBR were significant predictors of mortality (P < 0.05). CBR above 50 mg was a predictor of survival (P < 0.05).
CONCLUSIONS: Higher doses of calcium given per blood product transfused were associated with improved 30-d survival and decreased blood product transfusions.
摘要：
背景：凝血需要钙，心输出量,和外周血管阻力。在接受大量输血治疗的创伤患者中，有85％至94％的人出现了低钙血症。1这项研究的目的是评估在大量输血期间增加静脉钙剂给药与改善创伤患者生存率之间的关系。
方法：我们对在2年期间接受大量输血的创伤患者进行了回顾性分析。通过钙与血液产品的比率(CBR)计算每单位输注的血液产品施用的元素钙的剂量。卡方检验评估凝血功能障碍和30天死亡率之间的关联。双样本t检验评估CBR与凝血病之间的关联。双变量回归分析评估了CBR与每位患者输血的血液制品之间的关联。多变量逻辑回归分析，控制年龄，性别,凝血病,和损伤严重程度评分评估CBR和死亡率之间的关联。
结果：该研究包括77名患者。凝血病与30d死亡率增加相关(P<0.05)。存活患者的CBR高于死亡患者(P<0.05)。CBR与每位患者输注的总血液制品显著减少相关(P<0.05)。CBR与凝血功能障碍无关（P=0.24）。多因素logistic回归分析显示,损伤严重度评分≥16分、凝血功能障碍和CBR降低是死亡率的显著预测因素(P<0.05)。CBR高于50mg是生存的预测因子(P<0.05)。
结论：每次输血给予较高剂量的钙与提高30天生存率和减少输血有关。
方法：我们对在2年期间接受大量输血的创伤患者进行了回顾性分析。通过钙与血液产品的比率(CBR)计算每单位输注的血液产品施用的元素钙的剂量。卡方检验评估凝血功能障碍和30天死亡率之间的关联。双样本t检验评估CBR与凝血病之间的关联。双变量回归分析评估了CBR与每位患者输血的血液制品之间的关联。多变量逻辑回归分析，控制年龄，性别,凝血病,和损伤严重程度评分评估CBR和死亡率之间的关联。
结果：该研究包括77名患者。凝血病与30d死亡率增加相关(P<0.05)。存活患者的CBR高于死亡患者(P<0.05)。CBR与每位患者输注的总血液制品显著减少相关(P<0.05)。CBR与凝血功能障碍无关（P=0.24）。多因素logistic回归分析显示,损伤严重度评分≥16分、凝血功能障碍和CBR降低是死亡率的显著预测因素(P<0.05)。CBR高于50mg是生存的预测因子(P<0.05)。
结论：每次输血给予较高剂量的钙与提高30天生存率和减少输血有关。
