【摘要】：目的探討1種改良限制性輸血策略指導(dǎo)急診患者圍術(shù)期RBC輸注的安全性、可行性及臨床價(jià)值。方法將急診需輸血的成年患者47名,隨機(jī)分為實(shí)驗(yàn)組(以改良的輸血策略指導(dǎo)臨床輸血,n=23)和對(duì)照組(醫(yī)生依據(jù)《臨床輸血技術(shù)規(guī)范》按經(jīng)驗(yàn)進(jìn)行臨床輸血,n=24),記錄:1)估計(jì)失血量、手術(shù)時(shí)間、術(shù)中補(bǔ)液、麻醉后恢復(fù)室停留時(shí)間及住院時(shí)間,術(shù)后2、6、12、24、48、72 h及急診住院結(jié)束各時(shí)間點(diǎn)的HR、MAP、T,入院、入室、出室、術(shù)后24 h、術(shù)后72 h及住院結(jié)束時(shí)Hb的變化;2)輸血相關(guān)并發(fā)癥及死亡率;3)RBC輸注情況,圍術(shù)期自體或/和異體RBC輸注率與人均輸注量。結(jié)果實(shí)驗(yàn)組與對(duì)照組患者估計(jì)失血量、手術(shù)時(shí)間、術(shù)中補(bǔ)液、PACU停留時(shí)間及住院時(shí)間相近(P0.05),術(shù)后各觀察時(shí)間點(diǎn)的HR、MAP及T比較差異甚小(P0.05);出室及術(shù)后24 h Hb(g/L),分別為90.31±11.40 vs 100.88±16.75(P0.05),入院、入室、術(shù)后72 h及急診住院時(shí)Hb相近(P0.05);2組均無輸血相關(guān)不良反應(yīng)及死亡病例發(fā)生。異體RBC輸注率56.52%(13/23)vs 91.66%(22/24)(P0.05);人均輸血量(U)分別為2.00±2.41 vs 6.04±5.48(P0.05),已輸血患者異體紅細(xì)胞的人均輸注量(U)3.53±2.18 vs 6.59±5.4(P0.05)。結(jié)論采用本研究所涉改良限制性輸血策略或可更安全、有效指導(dǎo)臨床急診輸血,值得臨床進(jìn)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 鹵11.40 vs 100.88 鹵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 鹵11.40 vs 100.88 鹵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 鹵2.41 vs 6.04 鹵5.48 (P0.05), and the (U) of allogeneic erythrocytes was 3.53 鹵2.18 vs 6.59 鹵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.
【作者單位】： 遵義醫(yī)學(xué)院附屬醫(yī)院麻醉科;四川大學(xué)華西醫(yī)院麻醉科;
【基金】：衛(wèi)生部衛(wèi)生行業(yè)專項(xiàng)(NO:201002005) 貴州省社會(huì)發(fā)展攻關(guān)項(xiàng)目(黔科合SY字[2015]3051號(hào)) 遵義市科技計(jì)劃項(xiàng)目(遵市科合社字[201475號(hào)])
【分類號(hào)】：R457.1

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