严重感染患者输血与否的血红蛋白浓度参考标准研究

Exploration on reference standard of hemoglobin concentration for blood transfusion or not in patients with serious infection

目的探讨严重感染患者输血与否的血红蛋白浓度参考标准。方法回顾性分析2010年4月。2015年6月重庆市綦江区人民医院收治的严重感染贫血患者984例的临床资料。根据输血采用的不同的血红蛋白浓度标准将患者分为限制性输血组558例和开放性输血组426例。限制性输血组在血红蛋白浓度〈70g／L时予以输注红细胞1U，并使其维持在70～90g／L，开放性输血组在血红蛋白浓度〈100g/L时予以输注红细胞1U，并使其维持在100～120g/L。观察两组输血情况，分析两组输血前后氧动力学与代谢监测指标的变化，如氧输送（DO2）、氧耗量（VO2）、氧摄取率（O2ER）、中心性静脉血氧饱和度（ScvO2）。采用序贯器官衰竭估计评分（SOFA）评价器官功能衰竭情况。记录两组不同输血方案对预后的影响。结果限制性输血组红细胞输注量[（3．85±1．41）U]显著低于开放性输血组[（6．95±2．97）U]，差异有统计学意义（P〈0．05）。输血前，限制性输血组血红蛋白浓度显著低于开放性输血组（P〈0．05），输血后两组差异亦有统计学意义（P〈0．05）。输血后，两组DO2、VO2均较输血前显著升高，O2ER、ScvO2、血乳酸水平显著降低，差异均有统计学意义（P〈0．05）。但是两组输血后上述各项指标差异无统计学意义（P〉0．05）。两组患者住院期间SOFA各系统评分及总分比较，差异无统计学意义（P〉0．05）。两组30d病死率、心力衰竭发生率比较差异均无统计学意义（P〉0．05），但限制性输血组住院期间病死率（36.38％）显著低于开放性输血组（40．14％），差异有统计学意义（P〈0．05）。结论严重感染患者在血红蛋白浓度〈70g／L时输注红细胞，并使其维持在70～90g／L，有利于减少不必要的输血，且能满足机体代谢的需要，并改善预后。

Objective To explore the reference standard of hemoglobin concentration for blood transfusion or not in pa- tients with serious infection. Methods The clinical data of 94 patients with serious infection admitted to Qijiang People＇s Hospital of Chongqing City from April 2010 to June 2015 was analyzed retrospectively. According to de the difference of reference standard of hemoglobin concentration taken by blood transfusion, the patients were divided into 558 cases of limited blood transfusion group and 426 cases of open blood transfusion group. The limited blood transfu- sion group was given transfusion of red blood cells 1 U when hemoglobin concentration was lower than 70 g/L, and made it keep on 70-90 g/L; the open blood transfusion group was given transfusion of red blood cells 1 U when hemoglobin concentration was lower than 100 g/L, and made it keep on 100-120 g/L. The blood transfusion conditions were observed, the changes of oxygen dynamics and supersession indexes were analyzed, such as oxygen delivery （DO2）, oxygen consumption （VO2）, oxygen extraction ratio （O2ER）, central venous oxygen saturation （ScvO2）. Sequential organ failure assessment （SOFA） was used to evaluate the conditions of organ failure. The influence of different transfusion programs of the two groups was recorded. Results The amount of transfused red blood cells of limited blood transfusion group [（3.85±1.41） U] was lower than that of open blood transfusion group [（6.95±2.97） U], the difference was statisti- cally significant （P 〈 0.05）. Before blood transfusion, the hemoglobin concentration of limited blood transfusion group was lower than that of open blood transfusion group （P 〈 0.05）, after blood transfusion, the difference between the two groups was also significant （P 〈 0.05）. After blood transfusion, the levels of DO2, VO2 of the two groups were higher than before blood transfusion, the levels of O2ER, ScvO2, blood lactate were lower than those before blood transfusion, the differences were statistically significant （P 〈 0.05）. But the indexes above after blood transfusion in the two groupshad no statistically significant differences （P 〉 0.05）. There were no statistically significant differences of each system of SOFA scores and total scores during hospitalization between the two groups （P 〉 0.05）. The 30 d fatality rate and in- cidence of heart failure of the two groups had no statistically significant differences （P 〉 0.05）, while the fatality rate during hospitalization of limited blood transfusion group （36.38%） was lower than that of open blood transfusion group （40.14%）, the difference was statistically significant （P 〈 0.05）. Conclusion The patients with serious infection are giv- en transfusion of red blood cells when hemoglobin concentration is lower than 70 g/L, and makes it keep on 70-90 g/L, which is helpful to reduce unnecessary blood transfusion, and can meet the need of body metabolism and improve prog- nosis.