改良限制性输血策略指导急诊围术期红细胞输注初探

Initial study on the improved restrictive transfusion strategy for guiding infusion of red blood cells during perioperative period in emergency surgery

目的探讨1种改良限制性输血策略指导急诊患者围术期RBC输注的安全性、可行性及临床价值。方法将急诊需输血的成年患者47名,随机分为实验组(以改良的输血策略指导临床输血,n=23)和对照组(医生依据《临床输血技术规范》按经验进行临床输血,n=24),记录:1)估计失血量、手术时间、术中补液、麻醉后恢复室停留时间及住院时间,术后2、6、12、24、48、72 h及急诊住院结束各时间点的HR、MAP、T,入院、入室、出室、术后24 h、术后72 h及住院结束时Hb的变化;2)输血相关并发症及死亡率;3)RBC输注情况,围术期自体或/和异体RBC输注率与人均输注量。结果实验组与对照组患者估计失血量、手术时间、术中补液、PACU停留时间及住院时间相近(P>0.05),术后各观察时间点的HR、MAP及T比较差异甚小(P>0.05);出室及术后24 h Hb(g/L),分别为90.31±11.40 vs 100.88±16.75(P<0.05),入院、入室、术后72 h及急诊住院时Hb相近(P>0.05);2组均无输血相关不良反应及死亡病例发生。异体RBC输注率56.52%(13/23)vs 91.66%(22/24)(P<0.05);人均输血量(U)分别为2.00±2.41 vs 6.04±5.48(P<0.05),已输血患者异体红细胞的人均输注量(U)3.53±2.18 vs 6.59±5.4(P<0.05)。结论采用本研究所涉改良限制性输血策略或可更安全、有效指导临床急诊输血,值得临床进一步研究。

Objectives To observe the safety, feasibility and clinical research value of peri-operative transfusion trigger score, which was incorporated into a restrictive transfusion strategy for guiding perioperative RBC infusion in emergency patients. Methods 47 cases of emergency patients were randomly divided into two groups： improved restrictive transfusion group （group E, n = 23 ） and control group （group C, n = 24）. Blood loss, operative time, intraoperative fluid volume, PACU residence time and hospitalization time following emergency surgery were estimated. HR, MAP and changes in T waves were estimated at the time point of 2 h, 6 h, 12 h, 24 h, 48 h, 72 h and the termination of emergency hospitalization. Hb value changes were recorded when patients were hospitalized, pushed into and out of the operation room before and after operation, 24h and 72h after surgery and at the end of emergency hospitalization. Complications and mortality related to transfusion of patients from the two groups were recorded. RBC infusion rates of the two groups and per capita RBC infusion in patients transfused were recorded. Results There were no statistically significant differences between the two groups of patients in estimated blood loss, operative time, intraoperative fluid, PACU residence time and emergency hospitalization time. The differences in HR, MAP and T waves at 2 h, 6 h, 12 h, 48 h, 72 h and the ending points of emergency hospitalization between the two groups were not statistically significant. The Hb values of patients in Group C were higher than those in Group E at the time immediately following surgery when the patients were pushed out of the operation room and 24h postoperation （ P 〈 0. 05 ）. No statistically significant differences were found when comparing Hb values at the time when patients were hospitalized, pushed into the operation room, 72 h after surgery and at the end of emergency hospitalization. None of the patients had adverse reactions related to transfusion and no mortality occurred. Allogeneic RBC transfusion rate of group C （91.66%, 22/24） was higher than that of group E （56. 52%, 13/23） （P 〈0. 05）. The allogeneic RBC infusion per capita was 6. 04 ±5.48 in group C and was higher than that of group E （2. 00 ±2. 41 U） （P 〈0. 05）. In patients who weretransfused, the allogeneic RBC infusion per capita was 6. 59± 5.4 in group C and was higher than that in group E with 3.53 ± 2.18 U （ P 〈 0. 05 ）. Conclusion The improved restrictive transfusion strategy that was involved in this study is safe, effective, and clinically feasible, as well as providing valuable reference for further research.