本文關(guān)鍵詞：ICU患者輸注不同儲存期紅細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　論文類型：學(xué)位論文

  更多相關(guān)文章： 紅細胞 儲存損失 ICU 危重患者 療效 預(yù)后

【摘要】：目的:儲存血液的保存時間有限,離體的紅細胞功能主要取決于保養(yǎng)液的成分和保存時間,保存液只能延緩紅細胞衰老,不能阻止其老化。隨時間推移,紅細胞在儲存期間的形態(tài)和功能會發(fā)生一系列變化,因此有必要對紅細胞懸液儲存期內(nèi)紅細胞的形態(tài),功能及紅細胞保存液的變化進行檢測,了解紅細胞懸液保存期內(nèi)的變化規(guī)律。另一方面,紅細胞懸液進入人體造成的影響是一個復(fù)雜的過程,大量臨床研究報道了紅細胞儲存時間延長會對患者預(yù)后造成了不良影響,而如何平衡潛在的紅細胞儲存短缺和對血液的安全使用又是一個懸而未決的問題。ICU患者作為一個特殊群體,貧血比較普遍,加之基礎(chǔ)疾病往往較嚴重,輸血是挽救其生命的重要手段。目前,紅細胞體內(nèi)存活率的分析方法有熒光或放射性核素標記紅細胞測定,出于安全方面的原因,這些實驗尚未進入臨床試驗,因次對ICU患者輸注不同儲存期紅細胞懸液的臨床效應(yīng)的觀察顯得尤為重要。本課題旨在研究不同儲存期紅細胞形態(tài)和功能變化規(guī)律,評價各時期紅細胞的質(zhì)量,并通過觀察ICU患者輸注不同時期紅細胞懸液后的臨床效應(yīng),探討適合這類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:將同一獻血員的紅細胞懸液200ml儲存于4℃冰箱,分別于0天,7天,14天,21天,28天,35天分別無菌抽取血液入真空采血管,按照臨床檢驗操作規(guī)程檢測紅細胞的形態(tài),血常規(guī)指標(WBC,HB,HCT,MCV,MCH,PLT),血生化(K+,Na+,Ca2+,LA,LDH,Fe2+,Cl-,CO2),凝血指標(TT,INR,APTT,Fib),血氣指標(PCO2,PO2,P50,BE),紅細胞滲透脆性,游離血紅蛋白含量和紅細胞溶血率。統(tǒng)計計量資料符合正態(tài)分布者采用t檢驗,不符合正態(tài)分布者用秩和檢驗,計數(shù)資料采用卡方檢驗。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研究,對其輸血療效和預(yù)后進行病例回顧性研究。將納入研究的患者分為兩組,分別為輸入紅細胞儲存時間14天組和輸入紅細胞儲存時間"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評分,機械通氣時間,器官衰竭情況,ICU停留時間,院內(nèi)感染情況,輸血不良反應(yīng),住院總時間和死亡人數(shù)。統(tǒng)計資料符合正態(tài)分布的選用t檢驗,計數(shù)資料使用卡方檢驗。結(jié)果:1.紅細胞懸液隨貯存時間延長,形態(tài)發(fā)生了從光滑雙凹圓盤狀(7天)→光滑盤狀(14天)→棘形(21天)→光滑球形的規(guī)律性退行性變,WBC隨庫存時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,Hct從14天下降明顯后變化不大。紅細胞滲透脆性和紅細胞溶血率增加,紅細胞數(shù)量減少,游離血紅蛋白逐漸增高,K+,Ca2+,LDH等隨貯存時間延長而逐漸增高,Na+逐漸降低,而Cl-和Fe2+無明顯改變。Glu顯著降低,乳酸明顯增高。血氣指標顯示P50在儲存期14天下降較快,下降了8%,之后下降不明顯,至35天時為原來的85%,PO2,BE值隨貯存時間延長而逐漸增高,PH,PCO2則呈下降趨勢。2.患者輸血效果與患者APACHEII評分和輸血量,血液儲存時間密切相關(guān),而與其年齡,性別,進入ICU的血紅蛋白濃度,機械通氣時間,ICU停留時間無明顯關(guān)系�；颊哳A(yù)后與血液儲存時間有關(guān),平均庫血時間"g14天患者和平均庫血時間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%,較平均庫血時間14天患者高。結(jié)論:1.紅細胞隨著儲存時間的延長,表現(xiàn)出形態(tài)不可逆變化趨勢,紅細胞滲透脆性和游離血紅蛋白逐漸增高,紅細胞懸液生化和PCO2,PO2,P50均發(fā)生了變化,其變化主要于儲存期14天時最為明顯。2.輸注紅細胞平均儲存時間"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間無明顯相關(guān)性。建議ICU危重患者臨床輸血使用儲存時間14天的紅細胞懸液。
[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)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R457.13

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本文編號：1362929