术中限制性输血与开放性输血的临床对比研究  

Clinical comparative study of intraoperative restrictive transfusion and liberal transfusion

作　　者：陈炜[1] 孙建良[1] 赵凤庆[2] 陈海炳[3] 

机构地区：[1]浙江省嘉兴市第一医院麻醉科,嘉兴314000 [2]浙江省嘉兴市第一医院外科,嘉兴314000 [3]浙江省嘉兴市第一医院输血科,嘉兴314000

出　　处：《上海医学》2012年第4期284-286,共3页Shanghai Medical Journal

基　　金：卫生部科学研究基金-浙江省医药卫生重大科技计划(WKJ2008-2-021)资助项目

摘　　要：目的探讨术中限制性输血在节约用血、合理用血和降低输血相关不良反应中的作用。方法 2010年1-12月在浙江省嘉兴市第一医院实施预计出血量>400mL的大、中型手术的患者入选限制性输血组(组Ⅱ),结合术中输血分值评估体系实施限制性输血策略。在2009年1-12月符合同样入选标准的患者入选开放性输血组(组Ⅰ),实施开放性输血策略。采用便携式床边血气分析仪动态监测患者在围术期的血红蛋白(Hb)及红细胞比容(Hct)。结果与组Ⅰ相比,组Ⅱ的输血总量减少了32.1%。组Ⅱ的输血率、人均输血量和输血相关不良反应均显著低于组Ⅰ(P值均<0.05)。结论术中动态测定Hb、Hct,并根据输血分值评估体系评判,是实施限制性输血的有效手段,能有效控制术中不必要的输血,节约血资源,减少输血相关不良反应。Objective To investigate the role restrictive transfusion in blood saving, blood rational use, and the decrease of transfusion-related adverse reactions during operation. Methods From January to December 2010, according to the transfusion score evaluation system, restrictive transfusion was adopted in the patients （group Ⅱ） whose blood loss was expected to be more than 400 mL during the operation. From January to December 2009, operative patients with the same expected bleeding amount were liberally given a transfusion （group Ⅰ）. Perioperative hemoglobin （Hb） and hematocrit （Hct） were monitored with a bedside blood gas analyzer （i-STAT）. Results Compared with group Ⅰ, the total blood transfusion was reduced by 32. 12% in group Ⅱ. The ratio of transfusion, average per capita amount of blood transfusion, and incidence of transfusion- related adverse reactions in group Ⅱ were significantly lower than those in group Ⅰ （P〈0.05）. Conclusion A restrictive transfusion can be achieved by monitoring Hb and Hct and use of transfusion score evaluation system during operation. It is an effective measure to decrease unnecessary blood transfusions, save blood and reduce the incidence of transfusion-related adverse reactions. （Shanghai Med J, 2012, 35= 284-286）

关 键 词：限制性输血 动态监测 血红蛋白 红细胞比容 

分 类 号：R614[医药卫生—麻醉学]