组织灌注导向红细胞输注策略对重症患者预后的影响  

Effect of Tissue Perfusion Oriented Red Blood Cell Transfusion Strategy on Outcomes of Critically Ill Patients

作　　者：周翔[1] 刘大为[1] 隆云[1] 苏龙翔[1] 程卫[1] 张青[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院重症医学科,北京100730

出　　处：《协和医学杂志》2015年第5期361-368,共8页Medical Journal of Peking Union Medical College Hospital

基　　金：卫生公益性行业科研专项经费项目(201202011)

摘　　要：目的比较依据美国东部创伤外科学会/美国重症医学院/美国重症医学联合会(Eastern Association for Surgery of Trauma/American College of Critical Care Medicine/Society of Critical Care Medicine,EAST/ACCM/SCCM)成人创伤与重症患者输血指南(2009年)的红细胞(red blood cell,RBC)输注策略与组织灌注导向的RBC输注策略对重症患者预后影响的差异。方法北京协和医院重症医学科在2013年采用依据EAST/ACCM/SCCM成人创伤与重症患者输血指南(2009年)的RBC输注策略指导临床输血,2014年采用组织灌注导向的RBC输注策略指导临床输血。比较两年所有重症监护病房(intensive care unit,ICU)患者和急性生理学及慢性健康状况评分Ⅱ(Acute Physiology and Chronic Health EvaluationⅡ,APACHEⅡ)≥15分患者的住院死亡率、ICU停留时间、新发的器官功能损伤发病率、输RBC前平均血红蛋白(hemoglobin,Hb)水平、入ICU血乳酸水平(Lac入)、输RBC前血乳酸水平(Lac输RBC前)、人均RBC输注量,以及输血相关并发症发生率。结果2014年ICU收治患者2638例,2013年2110例。2014年患者平均入ICU APACHEⅡ评分及APACHEⅡ评分≥15分患者占所有患者比例均高于2013年(P<0.05)。2014年输注RBC患者占所有患者比例显著低于2013年(P<0.05)。两年间输血前Hb水平、Lac入、Lac入<4 mmol/L患者占所有患者比例差异均无统计学意义(P>0.05)。2014年Lac输RBC前显著高于2013年[(4.16±1.18)mmol/L比(2.78±1.03)mmol/L,P=0.031],2014年输RBC患者中Lac入<4 mmol/L患者占所有患者比例显著低于2013年(20.5%比33.4%,P=0.018),人均RBC输注量2014年比2013年显著下降[(1.02±0.51)U比(1.55±0.70)U,P=0.037]。全部ICU患者两年间住院死亡率差异无统计学意义(2.77%比2.39%,P=0.749),但平均ICU停留时间2014年明显较短[(5.31±1.98)d比(6.84±2.36)d,P=0.025];新发的急性肾损伤、急性肝损伤、急性心肌损伤及急性肺损伤的发病率两年间差异均无统计学意义(P>0.05)。而在Objective To compare the effects of Eastern Association for Surgery of Trauma/American＆amp;nbsp;College of Critical Care Medicine/Society of Critical Care Medicine （ EAST/ACCM/SCCM） red blood cell trans-fusion in adult trauma and critical care guidelines （2009） guided red blood cell （RBC） transfusion strategy and tissue perfusion oriented RBC transfusion strategy in critically ill patients. Methods In 2013, RBC transfusion in Department of Critical Care Medicine of Peking Union Medical College Hospital followed the EAST/ACCM/SC-CM guidelines recommendation in critically ill patients, and in 2014 tissue perfusion oriented RBC transfusion strategy was adopted. The in-hospital mortality, length of Intensive Care Unit （ ICU） stay, incidence of new or-gan injury, mean pre-transfusion hemoglobin （ Hb） level, blood lactate acid level upon admission （ Lac admit-ted）, pre-transfusion blood lactate acid level （Lac pre-transfusion）, mean RBC transfusion volume, and inci-dence of transfusion-related complications in all ICU patients and patients with Acute Physiology and Chronic Health Evaluation Ⅱ （ APACHE Ⅱ） ≥15 were compared between the year 2013 and the year 2014 . Results In 2013 and 2014, 2110 and 2638 patients were admitted to ICU, respectively. The mean APACHEⅡscore up-on admission and the proportion of patients with APACHEⅡ≥15 were both higher in 2014 than in 2013 （ P〈0. 05 ） . The proportion of patients treated with RBC transfusion was significantly lower in 2014 than in 2013 （P〈0. 05）. The mean pre-transfusion Hb level, Lac admitted, and the proportion of patients with Lac admitted〈4 mmol/L showed no significant difference between the two years （P〉0. 05）. Lac pre-transfusion in 2014 was significantlyhigherthanthatin2013[（4.16±1.18） mmol/Lvs. （2.78±1.03） mmol/L,P=0.031]. Inthe patients treated with RBC transfusion, the proportion of patients with Lac admitted〈4 mmol/L was significantly lower in 2014 than in 2013 （20. 5% vs. 33. 4%, P=0.

关 键 词：组织灌注 乳酸 红细胞 急性肾损害 急性心肌损害 急性肺损伤 

分 类 号：R457.1[医药卫生—治疗学]