限制性输血和开放性输血策略在贫血的机械通气患者中的比较

Restrictive versus liberal transfusion strategies for mechanically ventilated critically ill patients

目的通过对重症医学科(ICU)中贫血的机械通气患者实施限制性输血及开放性输血,比较两种不同的输血策略对患者的预后的影响。方法选择2012年6月-2014年6月期间入住我院重症医学科的需机械通气的贫血患者120例,随机分为限制性输血组(输血指征Hb≤70g/L;目标Hb71-90g/L)和开放性输血组(输血指征Hb≤90g/L;目标Hb91-110g/L)。比较两组的红细胞用量、平均血红蛋白值、机械通气时间、器官衰竭数量、ICU住院时间及病死率。结果两组患者的平均红细胞用量、干预后的Hb平均值以及机械通气时间均有显著差异(P<0.05),患者的器官衰竭数量、ICU住院时间及28d病死率无显著差异(P>0.05),但限制性输血组较开放性输血组60d病死率低(P<0.05)。结论采用限制性输血策略,可以在节约输血成本的同时,增加机械通气患者的60d内无机械通气时间,降低60d病死率。

Objective To compare patient outcomes when restrictive or liberal blood transfusion strategies are used to treat anemic critically ill patients requiring mechanical ventilation in ICU. Methods we choose 120 anemic （Hb≤90g/L） critically ill patients requiring mechanical ventilation during 2012.06 to 2014.06 in our department. Patients were randomized to a restrictive （Hb trigger,70g/L;target,71-90g/L） or liberal （90g/L;target,91-110g/L） transfusion strategy for 14 days or the remainder of ICU stay. To compare hemoglobin concentration （Hb）,RBC use,and patient outcomes of the two groups. Results There is difference in Hb,RBC use and ventilation-free days during 60d （P〈0.05）. There is no difference in organ failure,ICU length of stay days and 28d mortality （P〉0.05）. But the 60d mortality is lower in restrictive transfusion group （P〈0.05）. Conclusion The ventilation-free days during 60d are longer and 60d mortality is lower when restrictive transfusion strategies are used to treat anemic critically ill patients requiring mechanical ventilation in ICU.