本文關(guān)鍵詞：ICU患者輸注不同儲(chǔ)存期紅細(xì)胞懸液后的療效觀察　出處：《四川醫(yī)科大學(xué)》2015年碩士論文　論文類(lèi)型：學(xué)位論文

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【摘要】：目的:儲(chǔ)存血液的保存時(shí)間有限,離體的紅細(xì)胞功能主要取決于保養(yǎng)液的成分和保存時(shí)間,保存液只能延緩紅細(xì)胞衰老,不能阻止其老化。隨時(shí)間推移,紅細(xì)胞在儲(chǔ)存期間的形態(tài)和功能會(huì)發(fā)生一系列變化,因此有必要對(duì)紅細(xì)胞懸液儲(chǔ)存期內(nèi)紅細(xì)胞的形態(tài),功能及紅細(xì)胞保存液的變化進(jìn)行檢測(cè),了解紅細(xì)胞懸液保存期內(nèi)的變化規(guī)律。另一方面,紅細(xì)胞懸液進(jìn)入人體造成的影響是一個(gè)復(fù)雜的過(guò)程,大量臨床研究報(bào)道了紅細(xì)胞儲(chǔ)存時(shí)間延長(zhǎng)會(huì)對(duì)患者預(yù)后造成了不良影響,而如何平衡潛在的紅細(xì)胞儲(chǔ)存短缺和對(duì)血液的安全使用又是一個(gè)懸而未決的問(wèn)題。ICU患者作為一個(gè)特殊群體,貧血比較普遍,加之基礎(chǔ)疾病往往較嚴(yán)重,輸血是挽救其生命的重要手段。目前,紅細(xì)胞體內(nèi)存活率的分析方法有熒光或放射性核素標(biāo)記紅細(xì)胞測(cè)定,出于安全方面的原因,這些實(shí)驗(yàn)尚未進(jìn)入臨床試驗(yàn),因次對(duì)ICU患者輸注不同儲(chǔ)存期紅細(xì)胞懸液的臨床效應(yīng)的觀察顯得尤為重要。本課題旨在研究不同儲(chǔ)存期紅細(xì)胞形態(tài)和功能變化規(guī)律,評(píng)價(jià)各時(shí)期紅細(xì)胞的質(zhì)量,并通過(guò)觀察ICU患者輸注不同時(shí)期紅細(xì)胞懸液后的臨床效應(yīng),探討適合這類(lèi)特殊群體輸血的血液要求,為其安全有效輸血提供可靠的循證依據(jù)。方法:第一部分:將同一獻(xiàn)血員的紅細(xì)胞懸液200ml儲(chǔ)存于4℃冰箱,分別于0天,7天,14天,21天,28天,35天分別無(wú)菌抽取血液入真空采血管,按照臨床檢驗(yàn)操作規(guī)程檢測(cè)紅細(xì)胞的形態(tài),血常規(guī)指標(biāo)(WBC,HB,HCT,MCV,MCH,PLT),血生化(K+,Na+,Ca2+,LA,LDH,Fe2+,Cl-,CO2),凝血指標(biāo)(TT,INR,APTT,Fib),血?dú)庵笜?biāo)(PCO2,PO2,P50,BE),紅細(xì)胞滲透脆性,游離血紅蛋白含量和紅細(xì)胞溶血率。統(tǒng)計(jì)計(jì)量資料符合正態(tài)分布者采用t檢驗(yàn),不符合正態(tài)分布者用秩和檢驗(yàn),計(jì)數(shù)資料采用卡方檢驗(yàn)。第二部分:選取瀘州醫(yī)學(xué)院附屬醫(yī)院ICU科2014年1月1日到2014年12月30日行紅細(xì)胞輸注治療的危重癥患者共567例,符合條件的423例患者被納入此次試驗(yàn)研究,對(duì)其輸血療效和預(yù)后進(jìn)行病例回顧性研究。將納入研究的患者分為兩組,分別為輸入紅細(xì)胞儲(chǔ)存時(shí)間14天組和輸入紅細(xì)胞儲(chǔ)存時(shí)間"g14天組。記錄患者一般情況,入院診斷,ICU期間輸注的RBC總量及次數(shù),ICU期間輸血前后的血紅蛋白濃度,APACHEII評(píng)分,機(jī)械通氣時(shí)間,器官衰竭情況,ICU停留時(shí)間,院內(nèi)感染情況,輸血不良反應(yīng),住院總時(shí)間和死亡人數(shù)。統(tǒng)計(jì)資料符合正態(tài)分布的選用t檢驗(yàn),計(jì)數(shù)資料使用卡方檢驗(yàn)。結(jié)果:1.紅細(xì)胞懸液隨貯存時(shí)間延長(zhǎng),形態(tài)發(fā)生了從光滑雙凹圓盤(pán)狀(7天)→光滑盤(pán)狀(14天)→棘形(21天)→光滑球形的規(guī)律性退行性變,WBC隨庫(kù)存時(shí)間的增加而逐漸下降,到保存期末僅49.3%,RBC,Hb,PLT在14d之后下降明顯,Hb在21天變化最為劇烈,MCV和PLT表現(xiàn)為緩慢下降的變化趨勢(shì),Hct從14天下降明顯后變化不大。紅細(xì)胞滲透脆性和紅細(xì)胞溶血率增加,紅細(xì)胞數(shù)量減少,游離血紅蛋白逐漸增高,K+,Ca2+,LDH等隨貯存時(shí)間延長(zhǎng)而逐漸增高,Na+逐漸降低,而Cl-和Fe2+無(wú)明顯改變。Glu顯著降低,乳酸明顯增高。血?dú)庵笜?biāo)顯示P50在儲(chǔ)存期14天下降較快,下降了8%,之后下降不明顯,至35天時(shí)為原來(lái)的85%,PO2,BE值隨貯存時(shí)間延長(zhǎng)而逐漸增高,PH,PCO2則呈下降趨勢(shì)。2.患者輸血效果與患者APACHEII評(píng)分和輸血量,血液儲(chǔ)存時(shí)間密切相關(guān),而與其年齡,性別,進(jìn)入ICU的血紅蛋白濃度,機(jī)械通氣時(shí)間,ICU停留時(shí)間無(wú)明顯關(guān)系。患者預(yù)后與血液儲(chǔ)存時(shí)間有關(guān),平均庫(kù)血時(shí)間"g14天患者和平均庫(kù)血時(shí)間14天患者的院內(nèi)感染率分別為6.3%和4.1%,器官衰竭分別為2.8%和1.4%,患者死亡率分別為9.6%和6.5%,較平均庫(kù)血時(shí)間14天患者高。結(jié)論:1.紅細(xì)胞隨著儲(chǔ)存時(shí)間的延長(zhǎng),表現(xiàn)出形態(tài)不可逆變化趨勢(shì),紅細(xì)胞滲透脆性和游離血紅蛋白逐漸增高,紅細(xì)胞懸液生化和PCO2,PO2,P50均發(fā)生了變化,其變化主要于儲(chǔ)存期14天時(shí)最為明顯。2.輸注紅細(xì)胞平均儲(chǔ)存時(shí)間"g14天的ICU危重患者的院內(nèi)感染率和死亡率,器官衰竭率升高,而與患者的住院總時(shí)間無(wú)明顯相關(guān)性。建議ICU危重患者臨床輸血使用儲(chǔ)存時(shí)間14天的紅細(xì)胞懸液。
[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.

【學(xué)位授予單位】：四川醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R457.13

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相關(guān)期刊論文 前1條

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本文編號(hào)：1362929