入院24h内输注红细胞≥30U的创伤患者的预后分析  

Prognosis of trauma patients receiving red blood cell transfusion ≥30 U at the first 24 hours after admission

作　　者：许平波[1] 李文献[1] 邓小明[1] 熊源长[1] 万小健[1] 江来[1] 

机构地区：[1]第二军医大学附属长海医院麻醉科,上海200433

出　　处：《中华创伤杂志》2007年第8期583-586,共4页Chinese Journal of Trauma

摘　　要：目的 研究入院24h内输注红细胞≥30U患者的预后情况。方法 回顾性分析23例创伤后24h内输注红细胞≥30U患者的有关资料，根据预后将其分为生存组和死亡组，比较两组患者入院24h内各项生理学指标、实验室检查以及输血情况的差异。结果 与死亡组比较，生存组患者ISS≥30、序贯器官功能衰竭评估（sequential organ failure assessment，SOFA）≥10的比例较低（P〈0．05），代谢性酸中毒、低温的程度较轻（P〈0．05），且持续时间更短，但两组患者在输血量方面差异无统计学意义。结论 除伤情外，低温（≤35℃）、严重的代谢性酸中毒[pH≤7．15、动脉血乳酸（Lac）≥10mmol／L、碱缺失（BD）≥12mmol／L]均提示患者预后较差，因此早期积极的液体复苏和复温有助于提高患者的生存率。Objective To investigate the prognosis of trauma patients receiving red blood cell （RBC） transfusion ≥30 U within 24 hours after admission. Methods A total of 23 trauma patients with RBC transfusion ≥30 U in the first 24 hours after admission were reviewed and divided into two groups according to their prognosis,ie, survivor group （ n = 11 ） and death group （ n = 12）. The physiological indices, laboratory data and blood transfusion requirement of the two groups were compared. Results Compared with the death group, the proportion of the patients with the injury severity score （ISS）≥30 points and sequential organ failure assessment （SOFA） score ≥ 10 points was lower （P 〈 0. 05）, with more slight degree of metabolic acidosis and hypothermia（ P 〈 0.05 ） and shorter duration in the survivor group. But there was no significant statistical difference in blood transfusion requirements between two groups. Conclusions Besides injury severity, hypothermia （ ≤35℃ ） and serious metabolic acidosis （pH≤7.15, Lac≥10 mmol/L or BD≥12 mmol/L） in the first 24 hours ＇after admission signify a poor prognosis, suggesting that an early aggressive blood transfusion and rewarming therapy should be taken to decrease mortality in trauma patients.

关 键 词：多处创伤 输血 预后 低温 代谢性酸中毒 

分 类 号：R641[医药卫生—外科学]