目的:确定在骨盆环损伤和血流动力学不稳定(HDI)的患者中,提高输血阈值以进行腹膜前盆腔填塞的更新方案的有效性。
方法:
方法:回顾性回顾。
方法:城市一级创伤中心。
■严重受伤(损伤严重程度评分>15)的骨盆环损伤患者,在将腹膜前骨盆填充的红细胞(RBC)阈值从2个单位提高到4个单位之前和之后进行治疗。HDI定义为收缩压<90mmHg。
■出血死亡率,骨盆前间隙感染,和增加腹膜前盆腔填塞阈值前后的静脉血栓栓塞。
结果:纳入了166例患者:93例按照历史方案治疗,73例按照更新方案治疗。HDI存在于历史方案组的46.2%(n=43)和更新方案组的49.3%(n=36)(P=0.69)。HDI患者的中位年龄为35.0岁(四分位距26.0-52.0),74.7%(n=59)是男性,中位损伤严重程度评分为41.0分(四分位距29.0-50.0分).更新方案组中HDI患者的心率较低(105.0vs.120.0;P=0.004),在前24小时内需要更少的红细胞单位(6.0与8.0,P=0.03),年龄没有差异,损伤严重程度评分,到达时的收缩压,到达时的碱缺乏或乳酸,复苏血管内球囊阻断主动脉,复苏开胸手术,血管栓塞,或前路骨盆切开复位内固定(P>0.05)。在新方案下执行的PPP数量减少(8.3%与65.1%,P<0.0001),前盆腔感染较少(0.0%vs.13.9%,P=0.02),更少的VTE(8.3%与30.2%;P=0.02),急性失血性休克死亡人数无差异(5.6%vs.7.0%,P=1.00)。
结论:在骨盆环损伤的严重损伤患者中,将输血阈值从2个红细胞增加到4个单位,以进行骨盆填塞,可以减少骨盆前间隙感染和静脉血栓栓塞,而不会影响急性出血的死亡。
方法:治疗级别III。有关证据级别的完整描述,请参阅作者说明。
OBJECTIVE: To determine the effectiveness of an updated protocol that increased the transfusion threshold to perform preperitoneal pelvic packing in patients with pelvic ring injuries and hemodynamic instability (HDI).
METHODS: METHODS: Retrospective review.
METHODS: Urban level 1 trauma center.
UNASSIGNED: Severely injured (injury severity score > 15) patients with pelvic ring injuries treated before and after increasing the threshold to perform preperitoneal pelvic packing from 2 to 4 units of red blood cells (RBCs). HDI was defined as a systolic blood pressure <90 mm Hg.
UNASSIGNED: Mortality from hemorrhage, anterior pelvic space infections, and venous thromboembolisms before and after increasing preperitoneal pelvic packing threshold.
RESULTS: One hundred sixty-six patients were included: 93 treated under the historical protocol and 73 treated under the updated protocol. HDI was present in 46.2% (n = 43) of the historical protocol group and 49.3% (n = 36) of the updated protocol group (P = 0.69). The median age of patients with HDI was 35.0 years (interquartile range 26.0-52.0), 74.7% (n = 59) were men, and the median injury severity score was 41.0 (interquartile range 29.0-50.0). Patients with HDI in the updated protocol group had a lower heart rate on presentation (105.0 vs. 120.0; P = 0.004), required less units of RBCs over the first 24 hours (6.0 vs. 8.0, P = 0.03), and did not differ in age, injury severity score, systolic blood pressure on arrival, base deficit or lactate on arrival, resuscitative endovascular balloon occlusion of the aorta, resuscitative thoracotomy, angioembolization, or anterior pelvis open reduction internal fixation (P > 0.05). The number of PPPs performed decreased under the new protocol (8.3% vs. 65.1%, P < 0.0001), and there were fewer anterior pelvic infections (0.0% vs. 13.9%, P = 0.02), fewer VTEs (8.3% vs. 30.2%; P = 0.02), and no difference in deaths from acute hemorrhagic shock (5.6% vs. 7.0%, P = 1.00).
CONCLUSIONS: Increasing the transfusion threshold from 2 to 4 units of red blood cells to perform pelvic packing in severely injured patients with pelvic ring injuries decreased anterior pelvic space infections and venous thromboembolisms without affecting deaths from acute hemorrhage.
METHODS: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.