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Lancet Haematol:创伤性凝血的更佳疗法

2017-04-28 tianxuexin MedSci原创

有效治疗创伤性凝血病是重要的;然而,最佳疗法仍然是未知的。该研究的目的是比较一线疗法中使用新鲜冷冻血浆(FFP)或凝血因子浓缩物(CFC)逆转创伤性凝血功能障碍的疗效,输血需求的出现以及因此发展来的多器官功能衰竭。

有效治疗创伤性凝血病是重要的;然而,最佳疗法仍然是未知的。该研究的目的是比较一线疗法中使用新鲜冷冻血浆(FFP)或凝血因子浓缩物(CFC)逆转创伤性凝血功能障碍的疗效,输血需求的出现以及因此发展来的多器官功能衰竭。

这个单中心,平行,开放标签的随机试验在因斯布鲁克医科大学医院(因斯布鲁克,奥地利)的1级创伤中心进行。选取18-80岁创伤入院的患者并且损伤严重程度评分(ISS)大于15,有出血征象,以及使用旋转血栓弹性测量法(ROTEM)鉴定的异常纤维蛋白聚合或长时间凝血时间鉴定的血浆凝血病。患者有危及生命的受伤,进行过现场心肺复苏,孤立性脑损伤,烧伤,雪崩损伤或除凝血酸以外的院前凝血治疗。使用计算机生成的随机对照表,脑损伤和ISS分层,用封闭的不透明信封随机分配患者进行FFP(15 mL / kg体重)或CFC(主要是纤维蛋白原浓缩物[50 mg / kg体重] )。随机分组后立即开始出血管理,并持续至入院后24小时。主要临床终点是改良意向治疗人群(不包括停止治疗的患者)的多器官功能衰竭。凝血病的逆转和大量输血的需要是重要的次要临床疗效终点,这是决定继续或终止试验的原因。

2012年3月3日至2016年2月20日,292名筛查患者中有100人被随机分配到FFP(n = 48)和CFC(n = 52)。 6名患者(FFP组4名,CFC组2名)由于忽视排除标准或主要方案偏差而失去随访,停药。 FFP组44例,CFC组50例,纳入最终中期分析。研究因为无效和安全性原因而早期终止,具体原因是FFP组中需要拯救治疗的患者比例高于CFC组(FFP组为23 [52%],而在FFP组中为2%[4%]) CFC组;优势比[OR] 25·34 [95%CI 5·47-240·03],p <0·0001),大量输血需要增加(FFP组13例[30%] vs 6 [12] %],ORF = 3.03,P = 0·042)。 FFP组29例(66%),CFC组25例(50%)患者发生多器官功能衰竭(OR 1·92 [95%CI 0·78-4·86],p = 0·15 )。

研究结果强调了早期和有效的纤维蛋白原补充对多发性创伤中严重凝血功能衰竭的重要性。研究中可用的样本量似乎足以得出一线CFC优于FFP的结论。

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    2018-01-03 amyloid
  2. [GetPortalCommentsPageByObjectIdResponse(id=2025446, encodeId=d9c5202544695, content=<a href='/topic/show?id=66f93204223' target=_blank style='color:#2F92EE;'>#创伤性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32042, encryptionId=66f93204223, topicName=创伤性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=325a197, createdName=amyloid, createdTime=Wed Jan 03 08:58:00 CST 2018, time=2018-01-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2008237, encodeId=664f200823e0a, content=<a href='/topic/show?id=1066844469' target=_blank style='color:#2F92EE;'>#HAE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8444, encryptionId=1066844469, topicName=HAE)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=32d177, createdName=changfy, createdTime=Wed Nov 01 14:58:00 CST 2017, time=2017-11-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1828905, encodeId=6c3d182890592, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Sat Apr 29 07:58:00 CST 2017, time=2017-04-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1317281, encodeId=0323131e28173, content=<a href='/topic/show?id=74916e0414' target=_blank style='color:#2F92EE;'>#EMA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6704, encryptionId=74916e0414, topicName=EMA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a35a460, createdName=fengyi812, createdTime=Sun Apr 30 14:58:00 CST 2017, time=2017-04-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1335137, encodeId=68d1133513e7f, content=<a href='/topic/show?id=e7cc32022c7' target=_blank style='color:#2F92EE;'>#创伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32022, encryptionId=e7cc32022c7, topicName=创伤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=aa5a2500103, createdName=ms920641618706883, createdTime=Sun Apr 30 14:58:00 CST 2017, time=2017-04-30, status=1, ipAttribution=)]
    2017-11-01 changfy
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    2017-04-29 howi
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    2017-04-30 fengyi812
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