南方医科大学学报

南方医科大学学报 ›› 2017, Vol. 37 ›› Issue (01): 119-.

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输注高/低比例血浆及红细胞对创伤后需大量输血救治患者疗效的meta分析

虞芳，钟涛，武钢   

  • 出版日期:2017-01-20 发布日期:2017-01-20

Efficacy of high versus low plasma: red blood cell ratio resuscitation in patients with
severe trauma requiring massive blood transfusion: a meta-analysis

  • Online:2017-01-20 Published:2017-01-20

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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 CochraneLibrary 、 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。

Abstract: 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.