在城市学术医疗中心创伤和非创伤患者大输血协议中血液制品的利用
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Blood Product Utilization Among Trauma and
Nontrauma Massive Transfusion Protocols at an Urban
Academic Medical Center
背景与目的
全医院范围的大量输血协议(MTPs)主要是为创伤患者设计的，可能会导致为非创伤患者准备多余的血液制品。这项研究表明， 在城市学术医疗中心，明显创伤和非创伤性患者的MTPs中血液制品利用率差别较大。
方 法
2011年1月至2015年12月在城市学术医疗中心对有MTPs患者开展了血液制品利用的回顾性研究。创伤患者MTP包括6个红细胞（RBC）单位，5个血浆单位和1个血小板单位。非创伤患者MTP包括6个RBC和3个血浆单位。
结 果
有334例创伤性患者启用MTP，233例非创伤性启用MTP和77例非创伤性MTP转化为创伤性MTP（“切换激活”），所有非创伤性患者均没有创伤性出血（100％[233/ 233]）。非创伤性患者仅少数需要输注红细胞(1.3%95%置信区间(CI)，0.3%-3.7%)或血浆(3.4%95%可信区间，1.5%-6.7%)，且只有45.5%的患者需要输注血小板(95%可信区间，39.0%-52.1%)。与创伤和转化为创伤的患者相比，非创伤性患者能使红细胞、血浆和血小板减少的中位数降低(P<0.01)。且非创伤患者准备但未使用血小板的中位数也降低。创伤患者与转化为创伤患者的未使用血小板的中位数分别是1，0。创伤和转化为创伤患者中所有准备好的血小板未被使用的比例很高，分别为3.7%和17.8%。
结 论
大多数初始为非创伤性患者MTP没必要转换到创伤MTP（大量输血协议）。较少输血和未输注血浆和血小板制剂与患者一直处于非创伤性MTP有关。在未来的研究中，在全医院范围评估非创伤性MTPs的使用是有必要的，因为为非创伤患者群体设计MTP可能会产生一个关键的策略来优化血液产品的利用率，而不是创伤和非创伤患者通用MTP。
原始文献摘要
Patel E U, Ness P M, Marshall C E, et al. Blood Product Utilization Among Trauma and Nontrauma Massive Transfusion Protocols at an Urban Academic Medical Center[J]. Anesthesia & Analgesia, 2017:1.
BACKGROUND: Hospital-wide massive transfusion protocols (MTPs) primarily designed for trauma patients may lead to excess blood products being prepared for nontrauma patients.This study characterized blood product utilization among distinct trauma and nontrauma MTPs at a large, urban academic medical
center.
METHODS: A retrospective study of blood product utilization was conducted in patients who required an MTP activation between January 2011 and December 2015 at an urban academic medical center. Trauma MTP containers included 6 red blood cell (RBC) units, 5 plasma units, and 1 unit of apheresis platelets. Nontrauma MTP containers included 6 RBC and 3 plasma units.
RESULTS: There were 334 trauma MTP activations, 233 nontrauma MTP activations, and 77 nontrauma MTP activations that subsequently switched to a trauma MTP (“switched activations”). All nontrauma MTP activations were among bleeding patients who did not have a traumatic injury (100% [233/233]). Few patients with a nontrauma activation required ad hoctransfusion of RBC units (1.3% [95% confidence interval (CI), 0.3%–3.7%]) or plasma (3.4%[95% CI, 1.5%–6.7%]), and only 45.5% (95% CI, 39.0%–52.1%) required ad hoc transfusion of apheresis platelets. Compared to trauma and switched activations, nontrauma activations
transfused a lower median number of RBC, plasma, and apheresis platelet units (P < .001 for all comparisons). There was also a lower median number of prepared but unused plasma units for nontrauma activations (3; [interquartile range (IQR), 3–5]) compared to trauma (7; [IQR, 5–10]; P < .001) and switched activations (8; [IQR, 5–11]; P < .001). The median number of unused apheresis platelet units was 1 (IQR, 1–2) for trauma activations and 0 (IQR, 0–1) for switched activations. There was a high proportion of trauma and switched activations in which all of the prepared apheresis platelet units were unused (28.1% [95% CI, 23.4%–33.3%]
and9.1% [95% CI, 3.7%–17.8%], respectively).
CONCLUSIONS: The majority of initial nontrauma MTP activations did not require a switch to a trauma MTP. Patients remaining under a nontrauma MTP activation were associated with a lower number of transfused and unused plasma and apheresis platelet units. Future studies evaluating the use of hospital-wide nontrauma MTPs are warranted since an MTP designed for nontrauma patient populations may yield a key strategy to optimize blood product utilization in comparison to a universal MTP for both trauma and nontrauma patients. 麻醉学文献进展分享