小儿大面积烧伤休克期切痂术输血策略  

Transfusion strategy for escharectomy surgery in pediatric with large area burns during shock stage

作　　者：杨丽云[1,2] 吴承高 胡飘萍[1] 肖长辉[1] 刘威[1] 乐爱平[1] YANG Liyun;WU Chenggao;HU Piaoping;XIAO Changhui;LIU Wei;LE Aiping(Department of Blood Transfusion,The First Affiliated Hospital of Nanchang University,Nanchang 330006,China;Department of Clinical Laboratory,Hainan Cancer Hospital)

机构地区：[1]南昌大学第一附属医院输血科,江西南昌330006 [2]海南省肿瘤医院检验科

出　　处：《中国输血杂志》2018年第7期711-714,共4页Chinese Journal of Blood Transfusion

基　　金：江西省科技厅支撑计划(20151BBG70216);江西省科技重大项目(20144BBG70001)

摘　　要：目的探讨大面积烧伤休克期切痂术患儿的输血治疗策略。方法利用医院临床用血全程闭环智能路径管理与评价信息系统检索2014—2016年我院≤14岁小儿烧烫伤病例资料795例,回顾性分析并筛选纳入55例大面积烧伤休克期切痂术患儿,根据患者输血前不同血红蛋白（Hemoglobin,Hb）值分为限制性输血组（Hb≤70 g/L,n=25）和开放性输血组（Hb≤100 g/L,n=30）,分析二组患者临床基本资料、输血量、输血前后患者的红细胞（Red blood cell,RBC）计数、Hb值和血细胞比容（Hematocrit,Hct）、术后感染率、并发症、输血不良反应发生率、住院时长、30 d死亡率和治愈率指标。结果 1）各年龄组烧伤小儿中,1—〈5岁组发生风险最高,约占烧伤小儿半数（45. 5%）; 2）二组患儿的血浆输注量差异不具统计学意义（P〉0. 05）,但限制性输血组的红细胞输注量和输血总量均少于开放性输血组,差异均具统计学意义（P〈0. 05）; 3）与开放性输血组相比,限制性输血组输血24 h后的RBC、Hb、Hct值均显著升高,输血前后差异均具统计学意义（P〈0. 05）; 4）二组患者输血后的术后感染率、并发症、输血不良反应发生率、住院时长、30 d死亡率和治愈率均无统计学差异（P〉0. 05）。结论应加强1—5岁小儿的监管,以降低其烧烫伤风险;大面积烧伤休克期切痂术患儿在输注血浆胶体液抗休克治疗同时,临床上采用Hb≤70 g/L的红细胞输注阈值是安全有效、可行的。Objective To explore the transfusion strategy for escharectomy surgery in pediatric with large area burn during shock stage. Methods The clinical closed loop intelligent path management and evaluation information system was used to retrieve 795 cases of burn and scald in pediatric under 14 in our hospital from January 2014 to December 2016. Retrospective analysis and screening of 55 cases of escharectomy surgery in pediatric with large area burn during shock stage. According to the different hemoglobin（ Hb） value before transfusion,the patients were divided into restrictive transfusion group（ Hb≤70 g/L,n= 25） and liberal transfusion group（ Hb≤100 g/L,n= 30）,The basic clinical data,the amount of transfusion,red blood cell（ RBC） count,Hb value and Hematocrit（ Hct） of patients before and after transfusion,postoperative infection rate,complications,incidence of adverse reactions of transfusion,length of stay hospital,30-day mortality,and cure rate indicators in the two groups were analyzed. Results 1） Among the burned children of all age groups,the risk of the 1—5 year group was the highest,accounting for about half of the burned children（ 45. 5%）.2） There was no significant difference in plasma use between the two groups（ P〉0. 05）,but the amount of red blood cell transfusion and total transfusion in the restrictive transfusion group were lower than those in the liberal transfusion group. The differences were statistically significant.（ P〈0. 05）. 3） Compared with the liberal transfusion group,the values of RBC,Hb and Hct were significantly increased after 24 hours of transfusion in the restrictive transfusion group,The differences between before and after blood transfusion were statistically significant（ P〈0. 05）; 4） There were no significant differences in postoperative infection rate,complications,incidence of adverse reactions of transfusion,length of stay hospital,30 day mortality rate and cure rate between the two groups（ P〉0. 05）. Conclusion We shoul

关 键 词：小儿 大面积烧伤 休克期 限制性输血 输血阈值 

分 类 号：R457.1[医药卫生—治疗学] R722.142[医药卫生—临床医学]