ICU患者输注不同储存期红细胞悬液后的疗效观察

发布时间：2018-01-01 04:30

本文关键词：ICU患者输注不同储存期红细胞悬液后的疗效观察　出处：《四川医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:储存血液的保存时间有限,离体的红细胞功能主要取决于保养液的成分和保存时间,保存液只能延缓红细胞衰老,不能阻止其老化。随时间推移,红细胞在储存期间的形态和功能会发生一系列变化,因此有必要对红细胞悬液储存期内红细胞的形态,功能及红细胞保存液的变化进行检测,了解红细胞悬液保存期内的变化规律。另一方面,红细胞悬液进入人体造成的影响是一个复杂的过程,大量临床研究报道了红细胞储存时间延长会对患者预后造成了不良影响,而如何平衡潜在的红细胞储存短缺和对血液的安全使用又是一个悬而未决的问题。ICU患者作为一个特殊群体,贫血比较普遍,加之基础疾病往往较严重,输血是挽救其生命的重要手段。目前,红细胞体内存活率的分析方法有荧光或放射性核素标记红细胞测定,出于安全方面的原因,这些实验尚未进入临床试验,因次对ICU患者输注不同储存期红细胞悬液的临床效应的观察显得尤为重要。本课题旨在研究不同储存期红细胞形态和功能变化规律,评价各时期红细胞的质量,并通过观察ICU患者输注不同时期红细胞悬液后的临床效应,探讨适合这类特殊群体输血的血液要求,为其安全有效输血提供可靠的循证依据。方法:第一部分:将同一献血员的红细胞悬液200ml储存于4℃冰箱,分别于0天,7天,14天,21天,28天,35天分别无菌抽取血液入真空采血管,按照临床检验操作规程检测红细胞的形态,血常规指标(WBC,HB,HCT,MCV,MCH,PLT),血生化(K+,Na+,Ca2+,LA,LDH,Fe2+,Cl-,CO2),凝血指标(TT,INR,APTT,Fib),血气指标(PCO2,PO2,P50,BE),红细胞渗透脆性,游离血红蛋白含量和红细胞溶血率。统计计量资料符合正态分布者采用t检验,不符合正态分布者用秩和检验,计数资料采用卡方检验。第二部分:选取泸州医学院附属医院ICU科2014年1月1日到2014年12月30日行红细胞输注治疗的危重症患者共567例,符合条件的423例患者被纳入此次试验研究,对其输血疗效和预后进行病例回顾性研究。将纳入研究的患者分为两组,分别为输入红细胞储存时间14天组和输入红细胞储存时间"g14天组。记录患者一般情况,入院诊断,ICU期间输注的RBC总量及次数,ICU期间输血前后的血红蛋白浓度,APACHEII评分,机械通气时间,器官衰竭情况,ICU停留时间,院内感染情况,输血不良反应,住院总时间和死亡人数。统计资料符合正态分布的选用t检验,计数资料使用卡方检验。结果:1.红细胞悬液随贮存时间延长,形态发生了从光滑双凹圆盘状(7天)→光滑盘状(14天)→棘形(21天)→光滑球形的规律性退行性变,WBC随库存时间的增加而逐渐下降,到保存期末仅49.3%,RBC,Hb,PLT在14d之后下降明显,Hb在21天变化最为剧烈,MCV和PLT表现为缓慢下降的变化趋势,Hct从14天下降明显后变化不大。红细胞渗透脆性和红细胞溶血率增加,红细胞数量减少,游离血红蛋白逐渐增高,K+,Ca2+,LDH等随贮存时间延长而逐渐增高,Na+逐渐降低,而Cl-和Fe2+无明显改变。Glu显著降低,乳酸明显增高。血气指标显示P50在储存期14天下降较快,下降了8%,之后下降不明显,至35天时为原来的85%,PO2,BE值随贮存时间延长而逐渐增高,PH,PCO2则呈下降趋势。2.患者输血效果与患者APACHEII评分和输血量,血液储存时间密切相关,而与其年龄,性别,进入ICU的血红蛋白浓度,机械通气时间,ICU停留时间无明显关系。患者预后与血液储存时间有关,平均库血时间"g14天患者和平均库血时间14天患者的院内感染率分别为6.3%和4.1%,器官衰竭分别为2.8%和1.4%,患者死亡率分别为9.6%和6.5%,较平均库血时间14天患者高。结论:1.红细胞随着储存时间的延长,表现出形态不可逆变化趋势,红细胞渗透脆性和游离血红蛋白逐渐增高,红细胞悬液生化和PCO2,PO2,P50均发生了变化,其变化主要于储存期14天时最为明显。2.输注红细胞平均储存时间"g14天的ICU危重患者的院内感染率和死亡率,器官衰竭率升高,而与患者的住院总时间无明显相关性。建议ICU危重患者临床输血使用储存时间14天的红细胞悬液。
[Abstract]:Objective: stored blood preservation time is limited, from the composition and function of red cell preservation time mainly depends on the maintenance of body fluid, preservation solution can only delay the red cell senescence, cannot prevent the ageing. Over time, the morphology and function of red blood cells during storage will produce a series of changes, so it is necessary for red blood cell the storage period of suspension red blood cell morphology, function and the changes of Red Cell Storaging Solution were detected, understand the changes of red blood cell suspension preservation period. On the other hand, the effect of red cell suspension into the human body which is a complex process, a large number of clinical studies reported the prolonged storage of red blood cells will cause adverse effect on the prognosis of the patients, and how to balance the potential of red blood cell storage and safe use of blood shortage is a problem in suspense with.ICU as a special group, poor blood Pu Coupled with the times, often more serious underlying diseases, blood transfusion is an important means to save the life. At present, analysis method of red cell survival rate with fluorescent or radionuclide labeled red blood cell determination, for security reasons, these experiments have not yet entered clinical trials for observation of clinical effect on patients with ICU infusion of different storage red cell suspension is very important. This paper aims at the law of red blood cell morphology and function changes of different storage period, evaluate the quality of each period of red blood cells, and to observe the clinical effect of ICU patients in different periods of injection of red blood cells suspension, to explore suitable for this kind of special group of blood transfusion requirements. To provide reliable evidence for the safe and effective blood transfusion. Methods: the first part: the same blood donors of red blood cell suspension 200ml stored in the 4 C refrigerator, respectively in 0 days, 7 days, 14 days, 21 days, 28 days, 35 days Don't draw blood into the sterile vacuum vessel, according to clinical examination procedures and detection of red blood cell morphology, blood routine index (WBC, HB, HCT, MCV, MCH, PLT), blood biochemical (K+, Na+, Ca2+, LA, LDH, Fe2+, Cl-, CO2), blood coagulation index (TT, INR, APTT, Fib), blood gas indexes (PCO2, PO2, P50, BE), red cell osmotic fragility, free hemoglobin and erythrocyte hemolysis rate. Statistical measurement data with normal distribution were tested by T, does not meet the normal distribution using the rank sum test, count data by chi square test. The second part: from January 1, 2014 to December 30, 2014 from Affiliated Hospital of Luzhou Medical College ICU for red blood cell transfusion therapy in critically ill patients with a total of 567 cases, 423 cases of eligible patients were included in the experimental study, the effect of blood transfusion and prognosis were retrospectively analyzed. The cases will be included in the study were divided into two groups, respectively for the input of red blood cell storage Among the group of 14 days and the input of red blood cell storage time G14 day group. Record the general condition of patients, the hospital diagnosis, the total RBC and the number of ICU during the infusion of ICU, hemoglobin concentration during blood transfusion, before and after the APACHEII score, mechanical ventilation time, organ failure, ICU residence time, the situation of nosocomial infection, adverse transfusion reaction the total duration of hospitalization, and deaths. Statistical data with the t test of normal distribution, chi square test. Results: 1. red blood cell suspension with prolonged storage time, morphology changed from smooth biconcave (7 days), smooth disc (14 days), spike shape (21 days), regularity of degeneration of smooth spherical, WBC increased with the increase of stock time decreased gradually, to save the final only 49.3%, RBC, Hb, PLT decreased significantly after 14d, Hb changes in 21 days is the most dramatic, MCV and PLT showed a trend of slow decline, fell from 14 to Hct Obviously after little change. The erythrocyte osmotic fragility and erythrocyte hemolysis rate increase, reduce the number of red blood cells, hemoglobin increased gradually, K+, Ca2+, LDH etc. with the storage time increased, Na+ decreased gradually, while Cl- and Fe2+ had no obvious change in.Glu was significantly decreased, lactic acid increased significantly. The index of blood gas showed that P50 in the storage period of 14 days decreased rapidly, decreased by 8%, then decreased obviously at day 35 to 85% of the original, PO2, the BE value increased with storage time increased gradually, PH and PCO2 decreased in patients with.2. and APACHEII scores of patients with the effect of blood transfusion and blood transfusion, blood storage time is closely related. With age, gender, hemoglobin concentration in ICU, mechanical ventilation time, ICU stay time. No obvious relationship between prognosis and blood storage time, the average time of banked blood "G14 days average 14 days of banked blood patients and patients with nosocomial infection Rates were 6.3% and 4.1%, respectively, 2.8% and 1.4% organ failure, mortality were 9.6% and 6.5%, compared with the average time of 14 days of banked blood patients. Conclusion: 1. red blood cells with the extension of storage time and showed morphological irreversible trend, erythrocyte osmotic fragility and free hemoglobin increased erythrocyte suspension of biochemical and PCO2, PO2, P50 are changed, the main changes in the storage period of 14 days when the most obvious.2. red blood cell transfusion average storage rate of infection and mortality time G14 days ICU critically ill patients in the hospital, organ failure rate increased, but no significant correlation with the total hospitalization time of patients recommended clinical blood transfusion ICU patients using the storage time of 14 days of red cell suspension.

【学位授予单位】：四川医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R457.13

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