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标题:Hypocalcemia in trauma patients receiving massive transfusion.
时间:2019-12-03 19:58:32
DOI:10.1016/j.jss.2015.12.036
PMID:27083965
作者:Amanda Giancarelli;Kara L. Birrer;Rodrigo F. Alban
关键词:Blood coagulation;Blood transfusion;Calcium;Hypocalcemia;Resuscitation;Trauma
出版源: 《Journal of Surgical Research》 ,2015 ,202 (1) :182-187
摘要:Massive transfusion protocol (MTP) is increasingly used in civilian trauma resuscitation. Calcium is vital for coagulation, but hypocalcemia commonly occurs during massive transfusion due to citrate and serum calcium chelation. This study was conducted to determine the incidence of hypocalcemia and severe hypocalcemia in trauma patients who receive massive transfusion and to compare characteristics of patients with severeversusnonsevere hypocalcemia. This was a retrospective study of trauma patients who received massive transfusion between January 2009 and November 2013. The primary outcome was the incidence of hypocalcemia (ionized calcium [iCa] < 1.12 mmol/L) and severe hypocalcemia (iCa < 0.90 mmol/L). Secondary outcomes included calcium monitoring, calcium replacement, and correction of coagulopathy. There were 156 patients included; 152 (97%) experienced hypocalcemia, and 111 (71%) had severe hypocalcemia. Patients were stratified into iCa ≥ 0.90 (n= 45) and iCa < 0.90 (n= 111). There were no differences in demographics or baseline laboratories except the severe hypocalcemia group had higher baseline activated partial thromboplastin time (29.7 [23.7–50.9]versus25.8 [22.3–35.9],P= 0.003), higher lactic acid (5.8 [4.1–9.8]versus4.0 [3.1–7.8],P= 0.019), lower platelets (176 [108–237]versus208 [169–272],P= 0.003), and lower pH (7.14 [6.98–7.28]versus7.23 [7.14–7.33],P= 0.019). Mortality was higher in the severe hypocalcemia group (49%versus24%,P= 0.007). Patients in the iCa < 0.90 group received more blood products (34 [23–58]versus22 [18–30] units,P< 0.001), and calcium chloride (4 [2–7]versus3 [1–4] g,P= 0.002), but there was no difference in duration of MTP or final iCa. Neither group reached a median iCa > 1.12. Hypocalcemia is common during MTP, and vigilant monitoring is warranted. Research is needed to effectively manage hypocalcemia during massive transfusion.
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目录:
  • Hypocalcemia in trauma patients receiving massive transfusion
    • 1. Introduction
    • 2. Materials and methods
    • 3. Results
    • 4. Discussion
    • 5. Conclusions
    • Acknowledgment
    • Disclosure
    • References

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