较高剂量的钙与创伤患者的存活率有关。

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research Pub Date : 2024-11-01 DOI:10.1016/j.jss.2024.02.014

Dillon J. Wade MD , Collin Pilkington BS , J. Curran Henson MD, MS , Hanna K. Jensen MD, PhD , Kyle Kalkwarf MD , Avi Bhavaraju MD , Nolan Bruce MD , Stephen Bowman PhD , Joseph Margolick MD

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引用次数: 0

摘要

引言凝血、心输出量和外周血管阻力都需要钙。在接受大量输血治疗的创伤患者中，有 85% 至 94% 的患者会出现低钙血症1。本研究的目的是评估在大量输血期间增加静脉注射钙剂与提高创伤患者生存率之间的关系：我们对两年内接受大量输血的创伤患者进行了回顾性分析。通过钙与血制品比（CBR）计算出每单位血制品输注的元素钙剂量。卡方检验评估了凝血功能障碍与 30 天死亡率之间的关系。双样本 t 检验评估 CBR 与凝血功能障碍之间的关系。双变量回归分析评估了 CBR 与每位患者输血量之间的关系。控制年龄、性别、凝血功能障碍和损伤严重程度评分的多变量逻辑回归分析评估了 CBR 与死亡率之间的关系：研究共纳入 77 名患者。凝血功能障碍与 30 天死亡率增加有关（P 结论：凝血功能障碍与 30 天死亡率增加有关：每输注一次血液制品，钙剂剂量越大，30 天存活率越高，输血量越少。

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Higher Doses of Calcium Associated With Survival in Trauma Patients

Introduction

Calcium is required for coagulation, cardiac output, and peripheral vascular resistance. Between 85% and 94% of trauma patients treated with massive blood transfusion develop hypocalcemia.¹ The aim of this study is to evaluate the relationship between increased intravenous calcium administration during massive transfusion and improved survival of trauma patients.

Methods

We performed a retrospective analysis of trauma patients who received massive transfusion over a 2-y period. Doses of elemental calcium administered per unit of blood product transfused were calculated by calcium to blood product ratio (CBR). Chi-square test evaluated association between coagulopathy and 30-d mortality. Two-sample t-test evaluated association between CBR and coagulopathy. Bivariate regression analysis evaluated association between CBR and blood products transfused per patient. Multivariable logistic regression analysis, controlling for age, sex, coagulopathy, and Injury Severity Score evaluated the association between CBR and mortality.

Results

The study included 77 patients. Coagulopathy was associated with increased 30-d mortality (P < 0.05). Patients who survived had higher CBR than those who died (P < 0.05). CBR was associated with a significant reduction in total blood products transfused per patient (P < 0.05). CBR was not associated with coagulopathy (P = 0.24). Multivariable logistic regression analysis demonstrated that Injury Severity Score ≥16, coagulopathy and decreased CBR were significant predictors of mortality (P < 0.05). CBR above 50 mg was a predictor of survival (P < 0.05).

Conclusions

Higher doses of calcium given per blood product transfused were associated with improved 30-d survival and decreased blood product transfusions.

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来源期刊

Journal of Surgical Research 医学-外科

CiteScore

3.90

自引率

4.50%

发文量

627

审稿时长

138 days

期刊介绍： The Journal of Surgical Research: Clinical and Laboratory Investigation publishes original articles concerned with clinical and laboratory investigations relevant to surgical practice and teaching. The journal emphasizes reports of clinical investigations or fundamental research bearing directly on surgical management that will be of general interest to a broad range of surgeons and surgical researchers. The articles presented need not have been the products of surgeons or of surgical laboratories. The Journal of Surgical Research also features review articles and special articles relating to educational, research, or social issues of interest to the academic surgical community.