乳酸及碱缺失与创伤失血性休克患者急诊输血治疗的相关性探索  

Relationship between lactate and alkali deficiency and blood transfusion therapy in patients with traumatic hemor⁃rhagic shock

作　　者：张晓琳 苏双报 施建设[2] 吴耀建 ZHANG Xiaolin;SU Shuangbao;SHI Jianshe;WU Yaojian(Department of Blood Transfusion,the 910 th Hospital of the Joint Logistics Support Force of the Chinese People′s Liberation Army,Quanzhou 362000,China;Gen-eral Surgery Department,the 910 th Hospital of the Joint Logistics Support Force of the Chinese People′s Liberation Army,Quanzhou 362000,China)

机构地区：[1]中国人民解放军联勤保障部队第910医院输血科,福建泉州362000 [2]中国人民解放军联勤保障部队第910医院普通外科,福建泉州362000

出　　处：《中国输血杂志》2023年第6期508-511,共4页Chinese Journal of Blood Transfusion

基　　金：泉州市科技计划项目(2018N126S)。

摘　　要：目的探讨乳酸及碱缺失对创伤失血性休克患者有无急诊输注红细胞需求的影响。方法回顾性分析本院2019年1月—2021年12月期间126名创伤失血性休克患者,将有效救治(99例)病例根据入院24 h内有无输血结局分为未输血组(36例)与输血组(63例)。比较2组入院时乳酸(Lac)、碱缺失(BE)及血红蛋白(Hb)、血细胞比容(Hct)及24 h后血红蛋白(Hb)、血细胞比容(Hct)变化以及ICU住院天数,采用二元Logistic回归分析急诊入院时有无输血需求的危险因素,运用受试者工作曲线(ROC)分析各危险因素单独及联合指标与有无输血需求的相关性。结果未输血组入院时Lac平均水平(2.90±1.82)低于输血组(5.80±2.83)(P<0.05),而BE、Hb、Hct(-1.76±3.24,120.78±20.83,35.76±6.11)均高于输血组(-5.91±4.69,101.32±29.68,29.97±8.48)(P<0.05);入院24 h后2组Hb、Hct平均水平(92.75±16.66,78.49±15.91)、(27.62±5.24,22.60±4.74),均较入院时低(P<0.05);二元Logistic统计分析确定Lac(OR=1.74,95%CI 1.493-2.927,P<0.01)、BE(OR=0.77,95%CI 0.676-0.883,P<0.01)、Hb(OR=0.97,95%CI 0.954-0.989,P<0.01)、Hct(OR=0.90,95%CI 0.844=0.96,P<0.01)对创伤失血性休克患者有无红细胞输注需求有指导意义,且血乳酸升高是独立危险因素(P<0.05),而年龄与性别的影响不具有统计学意义(P>0.05);ROC曲线分析表明Lac及BE预测创伤失血性休克患者有无急诊输注红细胞需求AUG最大值分别为(0.875,0.766)明显优于Hb、Hct(0.692,0.682),Lac最佳阈值为3.6 mmol/L,Hb最佳阈值为106 g/L;联合四项检测指标获得AUG最大为0.910,较单独指标高。以Lac及Hb的最佳阈值作为输血指征比较预测价值,结果显示Lac预测价值优于Hb。结论Lac及BE对创伤失血性休克患者有无急诊输注红细胞需求具有一定的指导意义,二者联合Hb、Hct有助于更及时、更准确判断患者输血需求,优化急诊患者输血管理。Objective To explore the effect of lactate and alkali deficiency on the need for red blood cell transfusion in emergency of patients with traumatic hemorrhagic shock.Methods A total of 126 patients with traumatic hemorrhagic shock in our hospital from January 2019 to December 2021 were retrospectively analyzed,and the 99 cases with effective treatment were divided into two groups according to the outcome of blood transfusion within 24 hours after admission:non⁃transfusion group(n=36)and transfusion group(n=63).The changes of lactic acid(Lac),alkali deficiency(BE),hemoglobin(Hb),hematocrit(Hct)at admission,hemoglobin(Hb),hematocrit(Hct)24 hours after admission and the length of stay in ICU were compared between the two groups.The binary logistic regression was used to analyze the risk factors of whether there was a need for blood transfusion at the time of emergency admission.The correlation between individual and combined indicators of each risk factor and the need for blood transfusion were analyzed by the receiver operating curve(ROC).Re⁃sults The mean level of Lac(2.90±1.82)in the non⁃transfusion group at admission was lower than that in the transfusion group(5.80±2.83)(P<0.05),while BE、Hb and Hct(-1.76±3.24,120.78±20.83,35.76±6.11)were higher than those in the transfusion group(-5.91±4.69,101.32±29.68,29.97±8.48)(P<0.05).The mean levels of Hb and Hct in the two groups 24 hours after admission(92.75±16.66,78.49±15.91)and(27.62±5.24,22.60±4.74)were lower than those at ad⁃mission(P<0.05).Binary logistic statistical analysis confirmed that Lac(OR=1.74,95%CI 1.493-2.927,P<0.01),BE(OR=0.77,95%CI 0.676-0.883,P<0.01),Hb(OR=0.97,95%CI 0.954-0.989,P<0.01),Hct(OR=0.90,95%CI 0.844=0.96,P<0.01)had guiding significance for patients with traumatic hemorrhagic shock to have red blood cell transfusion demand,and the increase of blood lactic acid was an independent risk factor(P<0.05),while age and gender had no significant effect on it(P>0.05)The maximum AUG of Lac and BE(0.875,0.766)in predicting the ne

关 键 词：创伤 失血性休克 乳酸 碱缺失 输血管理 急诊 血红蛋白 碱缺乏 

分 类 号：R457.1[医药卫生—治疗学] R641[医药卫生—临床医学] R541.64