輸血を必要とした外傷症例における新鮮凍結血漿投与が転帰に及ぼす影響
【目的】輸血を必要とする重症外傷患者に対して，より多くの新鮮凍結血漿（FFP）を投与することによって転帰を改善する可能性があるかを検討した。【対象と方法】2006年1月から2010年12月までに当院救命救急センターに搬送された外傷患者のうち来院から24時間以内に赤血球濃厚液8単位以上を投与した患者を対象とし，来院から24時間までのFFPとRCCの投与比により，低FFP/RCC群（51例）高FFP/RCC群（54例）との2群に分けて比較検討した。【結果】対象症例は105例であり，年齢56.3±20.6歳，男性75例（71.4%），ISS 30.7±11.3だった。両群において年齢，性別，受傷機転...
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| Published in | 日本救急医学会雑誌 Vol. 23; no. 8; pp. 342 - 348 |
|---|---|
| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本救急医学会
2012
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| Subjects | |
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| Abstract | 【目的】輸血を必要とする重症外傷患者に対して，より多くの新鮮凍結血漿（FFP）を投与することによって転帰を改善する可能性があるかを検討した。【対象と方法】2006年1月から2010年12月までに当院救命救急センターに搬送された外傷患者のうち来院から24時間以内に赤血球濃厚液8単位以上を投与した患者を対象とし，来院から24時間までのFFPとRCCの投与比により，低FFP/RCC群（51例）高FFP/RCC群（54例）との2群に分けて比較検討した。【結果】対象症例は105例であり，年齢56.3±20.6歳，男性75例（71.4%），ISS 30.7±11.3だった。両群において年齢，性別，受傷機転，来院時血圧，体温，ISS，RTS，Ps，Hb，PT-INR，BE，APACHE II，SOFA scoreに有意差はなく，来院から24時間以内のRCCと血小板投与量にも有意差はなかった。両群の24時間の生存率は64.7%と83.3%，生存退院率は54.9%と74.1%であり，ともに高FFP/RCC群の方が有意に高かった（p<0.05）。【結論】大量輸血を要する外傷患者に対して，積極的にFFPを投与することにより転帰を改善する可能性がある。 |
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| AbstractList | 【目的】輸血を必要とする重症外傷患者に対して，より多くの新鮮凍結血漿（FFP）を投与することによって転帰を改善する可能性があるかを検討した。【対象と方法】2006年1月から2010年12月までに当院救命救急センターに搬送された外傷患者のうち来院から24時間以内に赤血球濃厚液8単位以上を投与した患者を対象とし，来院から24時間までのFFPとRCCの投与比により，低FFP/RCC群（51例）高FFP/RCC群（54例）との2群に分けて比較検討した。【結果】対象症例は105例であり，年齢56.3±20.6歳，男性75例（71.4%），ISS 30.7±11.3だった。両群において年齢，性別，受傷機転，来院時血圧，体温，ISS，RTS，Ps，Hb，PT-INR，BE，APACHE II，SOFA scoreに有意差はなく，来院から24時間以内のRCCと血小板投与量にも有意差はなかった。両群の24時間の生存率は64.7%と83.3%，生存退院率は54.9%と74.1%であり，ともに高FFP/RCC群の方が有意に高かった（p<0.05）。【結論】大量輸血を要する外傷患者に対して，積極的にFFPを投与することにより転帰を改善する可能性がある。 |
| Author | 牧, 真彦 松田, 潔 萩原, 一樹 宮崎, 善史 岩瀬, 史明 岩瀬, 弘明 小林, 辰輔 |
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| References | 26) The University of Texas Health Science Center at Houston: PRospective, Observational, Multi-center Massive Transfusion sTudy. Available online at:http:www.uth.tmc edu/cetir/PROMMTT/ Accessed December 18, 2011. 21) 日本外傷学会･日本救急医学会監修: 第3章外傷と循環. 改訂第3版. 外傷初期診療ガイドライン. へるす出版, 東京, 2008, p43-55. 7) Hirshberg A, Dugas M, Banez EI, et al: Minimizing dilutional coagulopathy in exsanguinating hemorrhage: a computer simulation. J Trauma. 2003; 54: 454-63. 17) Gunter OL, Au BK, Isbell JM, et al: Optimizing outcomes in damage control resuscitation: identifying blood product ratios associated with improved survival. J Trauma. 2008; 65: 527-34. 22) Kashuk JL, Moore EE, Johnson JL, et al: Postinjury life threatening coagulopathy: is 1:1 fresh frozen plasma: packed red blood cells the answer? J Trauma. 2008; 65: 261-71. 2) Rotondo MF, Schwab CW, McGonigal MD, et al: “Damage control”: an approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma. 1993; 35: 375-83. 3) Kirkpatrick AW, Ball C, D'Amours SK, et al: Acute resuscitation of the unstable adult trauma patient: bedside diagnosis and therapy. Can J Surg. 2008; 51: 57-69. 15) Shaz BH, Dente CJ, Nicholas J, et al: Increased number of coagulation products in relationship to red blood cell products transfused improves mortality in trauma patients. Transfusion. 2010; 50: 493-500. 23) Murad MH, Stubbs JR, Gandhi MJ, et al: The effect of plasma transfusion on morbidity and mortality: a systematic review and meta-analysis.Transfusion. 2010; 50: 1370-83. 18) Schuster KM, Davis KA, Lui FY, et al: The status of massive transfusion protocols in United States trauma centers: massive transfusion or massive confusion? Transfusion. 2010; 50: 1545-51. 10) Sperry JL, Ochaoa JB, Gunn SR, et al: An FFP:PRBC transfusion ratio >=1:1.5 is associated with a lower risk of mortality after massive transfusion. J Trauma. 2008; 65: 986-93. 11) Maegele M, Lefering R, Paffrath T, et al: Red blood cell to plasma ratio transfused during massive transfusion are associated with mortality in severe multiply injury: a retrospective analysis from the trauma registry of the Deutsche Gedellschaft fur Unfallchirurgie. Vox Sanguinis. 2008; 95: 112-9. 14) Magnotti LJ, Zarzaur BL, Fischer PE, et al: Improved survival after hemostatic resuscitation: does the emperer have no clothes? J Trauma. 2011; 70: 97-102. 6) Cinat ME, Wallace WC, Nastanski F, et al: Improved survival following massive transfusion in patients who have undergone trauma. Arch Surg. 1999; 134: 964-8. 20) 厚生労働省: 別添2［要約］新鮮凍結血漿の適正使用.「輸血療法の実施に関する指針」（改訂版）及び「血液製剤の使用指針」（改訂版）（平成21年2月一部改正）. p8-10. 24) Johansson PI, Stensballe J: Hemostatic resuscitation for massive bleeding: the paradigm of plasma and platelets--a review of the current literature.Transfusion. 2010; 50: 701-10. 5) Teixeira PGR, Inaba K, Shulman I, et al: Impact of plasma transfusion in massively transfused trauma patients. J Trauma. 2009; 66: 693-7. 13) Cotton BA, Au BK, Nunez TC, et al: Predifined massive transfusion protocols are associated with a reduction in organ failure and postinjury complications. J Trauma. 2009; 66: 41-9. 9) Duchesne JC, Hunt JP, Wahl G, et al: Review of current blood transfusions strategies in a mature level I trauma center: were we wrong for the last 60 years? J Trauma. 2008; 65: 272-8. 19) Dente CJ, Shaz BH, Nicholas JM, et al: Improvements in early mortality and coagulopathy are sustained better in patients with blunt trauma after institution of a massive transfusion protocol in a civilian level I trauma center. J Trauma. 2009; 66: 1616-24. 12) Holcomb JB, Wade CE, Michalek JE, et al: Increased plasma and platelet to red blood cell ratios improves outcome in 466 massively transfused civilian trauma patients. Ann Surg. 2008; 248: 447-58. 8) Borgman MA, Spinella PC, Perkins JG, et al: The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital. J Trauma. 2007; 63: 805-13. 1) Kauvar DS, Lefering R, Wade CE: Impact of hemorrhage on trauma outcome: an overview of epidemiology, clinical presentations and therapeutic considerations. J Trauma. 2006; 60: S3-S11. 25) Rajasekhar A, Gowing R, Zarychanski R, et al: Survival of trauma patients after massive red blood cell transfusion using a high or low red blood cell to plasma transfusion ratio. Crit Care Med. 2011; 39: 1507-13. 4) Gonzalez EA, Moore FA, Holcomb JB, et al: Fresh frozen plasma should be given earlier to patients requiring massive transfusion. J Trauma. 2007; 62: 112-9. 16) Cotton BA, Gunter OL, Isbell J, et al: Damage control hematology: the impact of a trauma exsanguination protocol on survival and blood product utilization. J Trauma. 2008; 64: 1177-83. |
| References_xml | – reference: 16) Cotton BA, Gunter OL, Isbell J, et al: Damage control hematology: the impact of a trauma exsanguination protocol on survival and blood product utilization. J Trauma. 2008; 64: 1177-83. – reference: 6) Cinat ME, Wallace WC, Nastanski F, et al: Improved survival following massive transfusion in patients who have undergone trauma. Arch Surg. 1999; 134: 964-8. – reference: 11) Maegele M, Lefering R, Paffrath T, et al: Red blood cell to plasma ratio transfused during massive transfusion are associated with mortality in severe multiply injury: a retrospective analysis from the trauma registry of the Deutsche Gedellschaft fur Unfallchirurgie. Vox Sanguinis. 2008; 95: 112-9. – reference: 9) Duchesne JC, Hunt JP, Wahl G, et al: Review of current blood transfusions strategies in a mature level I trauma center: were we wrong for the last 60 years? J Trauma. 2008; 65: 272-8. – reference: 3) Kirkpatrick AW, Ball C, D'Amours SK, et al: Acute resuscitation of the unstable adult trauma patient: bedside diagnosis and therapy. Can J Surg. 2008; 51: 57-69. – reference: 14) Magnotti LJ, Zarzaur BL, Fischer PE, et al: Improved survival after hemostatic resuscitation: does the emperer have no clothes? J Trauma. 2011; 70: 97-102. – reference: 5) Teixeira PGR, Inaba K, Shulman I, et al: Impact of plasma transfusion in massively transfused trauma patients. J Trauma. 2009; 66: 693-7. – reference: 7) Hirshberg A, Dugas M, Banez EI, et al: Minimizing dilutional coagulopathy in exsanguinating hemorrhage: a computer simulation. J Trauma. 2003; 54: 454-63. – reference: 10) Sperry JL, Ochaoa JB, Gunn SR, et al: An FFP:PRBC transfusion ratio >=1:1.5 is associated with a lower risk of mortality after massive transfusion. J Trauma. 2008; 65: 986-93. – reference: 20) 厚生労働省: 別添2［要約］新鮮凍結血漿の適正使用.「輸血療法の実施に関する指針」（改訂版）及び「血液製剤の使用指針」（改訂版）（平成21年2月一部改正）. p8-10. – reference: 15) Shaz BH, Dente CJ, Nicholas J, et al: Increased number of coagulation products in relationship to red blood cell products transfused improves mortality in trauma patients. Transfusion. 2010; 50: 493-500. – reference: 24) Johansson PI, Stensballe J: Hemostatic resuscitation for massive bleeding: the paradigm of plasma and platelets--a review of the current literature.Transfusion. 2010; 50: 701-10. – reference: 21) 日本外傷学会･日本救急医学会監修: 第3章外傷と循環. 改訂第3版. 外傷初期診療ガイドライン. へるす出版, 東京, 2008, p43-55. – reference: 4) Gonzalez EA, Moore FA, Holcomb JB, et al: Fresh frozen plasma should be given earlier to patients requiring massive transfusion. J Trauma. 2007; 62: 112-9. – reference: 22) Kashuk JL, Moore EE, Johnson JL, et al: Postinjury life threatening coagulopathy: is 1:1 fresh frozen plasma: packed red blood cells the answer? J Trauma. 2008; 65: 261-71. – reference: 17) Gunter OL, Au BK, Isbell JM, et al: Optimizing outcomes in damage control resuscitation: identifying blood product ratios associated with improved survival. J Trauma. 2008; 65: 527-34. – reference: 23) Murad MH, Stubbs JR, Gandhi MJ, et al: The effect of plasma transfusion on morbidity and mortality: a systematic review and meta-analysis.Transfusion. 2010; 50: 1370-83. – reference: 12) Holcomb JB, Wade CE, Michalek JE, et al: Increased plasma and platelet to red blood cell ratios improves outcome in 466 massively transfused civilian trauma patients. Ann Surg. 2008; 248: 447-58. – reference: 25) Rajasekhar A, Gowing R, Zarychanski R, et al: Survival of trauma patients after massive red blood cell transfusion using a high or low red blood cell to plasma transfusion ratio. Crit Care Med. 2011; 39: 1507-13. – reference: 1) Kauvar DS, Lefering R, Wade CE: Impact of hemorrhage on trauma outcome: an overview of epidemiology, clinical presentations and therapeutic considerations. J Trauma. 2006; 60: S3-S11. – reference: 18) Schuster KM, Davis KA, Lui FY, et al: The status of massive transfusion protocols in United States trauma centers: massive transfusion or massive confusion? Transfusion. 2010; 50: 1545-51. – reference: 19) Dente CJ, Shaz BH, Nicholas JM, et al: Improvements in early mortality and coagulopathy are sustained better in patients with blunt trauma after institution of a massive transfusion protocol in a civilian level I trauma center. J Trauma. 2009; 66: 1616-24. – reference: 13) Cotton BA, Au BK, Nunez TC, et al: Predifined massive transfusion protocols are associated with a reduction in organ failure and postinjury complications. J Trauma. 2009; 66: 41-9. – reference: 26) The University of Texas Health Science Center at Houston: PRospective, Observational, Multi-center Massive Transfusion sTudy. Available online at:http:www.uth.tmc edu/cetir/PROMMTT/ Accessed December 18, 2011. – reference: 2) Rotondo MF, Schwab CW, McGonigal MD, et al: “Damage control”: an approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma. 1993; 35: 375-83. – reference: 8) Borgman MA, Spinella PC, Perkins JG, et al: The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital. J Trauma. 2007; 63: 805-13. |
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| Title | 輸血を必要とした外傷症例における新鮮凍結血漿投与が転帰に及ぼす影響 |
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