改良限制性输血策略指导急诊围术期红细胞输注初探

发布时间：2018-08-18 15:51

【摘要】：目的探讨1种改良限制性输血策略指导急诊患者围术期RBC输注的安全性、可行性及临床价值。方法将急诊需输血的成年患者47名,随机分为实验组(以改良的输血策略指导临床输血,n=23)和对照组(医生依据《临床输血技术规范》按经验进行临床输血,n=24),记录:1)估计失血量、手术时间、术中补液、麻醉后恢复室停留时间及住院时间,术后2、6、12、24、48、72 h及急诊住院结束各时间点的HR、MAP、T,入院、入室、出室、术后24 h、术后72 h及住院结束时Hb的变化;2)输血相关并发症及死亡率;3)RBC输注情况,围术期自体或/和异体RBC输注率与人均输注量。结果实验组与对照组患者估计失血量、手术时间、术中补液、PACU停留时间及住院时间相近(P0.05),术后各观察时间点的HR、MAP及T比较差异甚小(P0.05);出室及术后24 h Hb(g/L),分别为90.31±11.40 vs 100.88±16.75(P0.05),入院、入室、术后72 h及急诊住院时Hb相近(P0.05);2组均无输血相关不良反应及死亡病例发生。异体RBC输注率56.52%(13/23)vs 91.66%(22/24)(P0.05);人均输血量(U)分别为2.00±2.41 vs 6.04±5.48(P0.05),已输血患者异体红细胞的人均输注量(U)3.53±2.18 vs 6.59±5.4(P0.05)。结论采用本研究所涉改良限制性输血策略或可更安全、有效指导临床急诊输血,值得临床进一步研究。
[Abstract]:Objective to explore the safety, feasibility and clinical value of a modified restrictive transfusion strategy for perioperative RBC infusion in emergency patients. Methods 47 adult patients who needed blood transfusion in emergency department were randomly divided into two groups: the experimental group (using modified transfusion strategy to guide the clinical transfusion) and the control group (the doctors performed the clinical blood transfusion according to the experience according to the Technical Specification for Clinical Transfusion), and the blood loss was recorded at 1: 1. Operation time, intraoperative fluid resuscitation, recovery room stay time and hospitalization time after anesthesia, HRP MAPT at every time point after operation, admission, entry and exit, and HRP MAPT at the end of emergency hospital stay were 26 / 12, 24 / 48 / 72 h after operation, respectively. Changes of HB at 24 h, 72 h after operation and at the end of hospitalization 2) transfusion related complications and mortality (3) RBC infusion, perioperative autologous or / and allogeneic RBC infusion rate and per capita infusion volume. Results the mean blood loss, operative time, stay time and hospitalization time of the patients in the experimental group and the control group were similar (P0.05). There was no significant difference in map and T between the observation time points after operation (P0.05), and the differences between the two groups were 90.31 卤11.40 vs 100.88 卤16.75 (P0.05), respectively, compared with the control group (P 0.05), and the difference of HRN map and T between the two groups was not significant (P0.05), and the difference was 90.31 卤11.40 vs 100.88 卤16.75 (P0.05), respectively. There were no transfusion related adverse reactions and death cases in both groups (P0.05). The transfusion rate of allogeneic RBC was 56.52% (13 / 23) vs 91.66% (22 / 24) (P0.05), and the (U) per capita transfusion was 2.00 卤2.41 vs 6.04 卤5.48 (P0.05), and the (U) of allogeneic erythrocytes was 3.53 卤2.18 vs 6.59 卤5.4 (P0.05). Conclusion the modified restrictive blood transfusion strategy mentioned in this study may be more safe and effective in guiding clinical emergency blood transfusion, which is worthy of further clinical study.
【作者单位】：遵义医学院附属医院麻醉科;四川大学华西医院麻醉科;
【基金】：卫生部卫生行业专项(NO:201002005) 贵州省社会发展攻关项目(黔科合SY字[2015]3051号) 遵义市科技计划项目(遵市科合社字[201475号])
【分类号】：R457.1

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