ICU患者输入不同储存时间红细胞悬液后的临床效果评价

Evaluation of transfusion efficacy in ICU patients transfused with blood of different storage time

目的通过观察ICU患者输注不同储存时间红细胞悬液后的临床效应,探讨适合这类特殊群体输血的血液要求,为其安全有效输血提供可靠的循证依据。方法选取西南医科大学附属医院ICU科,2014年1月1日-2014年12月30日,行红细胞输注治疗的符合条件的危重症患者423例纳入此次试验研究,对其输血疗效和预后进行病例回顾性研究。将纳入研究的患者分为2组,分别为输入平均红细胞储存时间<14 d组和输入平均红细胞储存时间≥14 d组。记录患者一般情况,入院诊断,ICU期间输注的RBC总量及次数,ICU期间输血前后的血红蛋白浓度,APACHEⅡ评分,机械通气时间,器官衰竭情况,ICU停留时间,院内感染情况,输血不良反应,住院总时间和死亡人数。统计资料符合正态分布的选用t检验,计数资料使用卡方检验。结果患者输血效果与患者APACHEII评分和输血量,血液储存时间密切相关,而与其年龄,性别,进出ICU的血红蛋白浓度,机械通气时间,ICU停留时间无明显关系。患者预后与血液储存时间有关,平均库血时间≥14 d患者和平均库血时间<14 d患者的院内感染率分别为6.3%和4.1%,器官衰竭分别为2.8%和1.4%,患者死亡率分别为9.6%和6.5%。结论输注红细胞平均储存时间≥14 d的ICU危重患者的院内感染率和死亡率,器官衰竭率升高,建议ICU危重患者使用储存时间<14 d的红细胞悬液。

Objective To explore blood transfusion requirements for critically ill patients in ICU who were given RBCs of different storage time and to provide a safe,effective and reliable evidence-based method through observation of patients’ transfusion reactions. Methods 423 eligible patients which were critically ill in ICU from Affiliated Hospital Of Sichuan Medical University and received RBC transfusion therapy from January 1st,2014 to December 30 th,2014 were selected. A retrospective study was conducted on the curative effect and effectiveness of blood transfusion on these patients. Patients included in the study were divided into two groups： a group with average red blood cell storage time 〈 14 days and another group with average red blood cell storage time≥14 days. Patients’ information were then recorded,such as general conditions,diagnosis,total number of RBC,transfusion frequency,hemoglobin concentration before and after blood transfusion during the ICU stay,APACHEII scores,hematocrit,duration of mechanical ventilation,organ failure cases,ICU stay time,nosocomial infection,adverse effect of transfusion,total hospitalization time and mortality. Measured data were analyzed using the statistical analysis program. T test was used on the data which corresponded with normal distribution,while chi-square test was used on enumerated data. Results The effect of blood transfusion in critically ill patients is closely related to the APACHEII score and the total number of transfusion,but played no significant role in the lifespan of blood,gender,ICU admission hemoglobin concentration,duration of mechanical ventilation and ICU stay. The prognosis of patients was related to the blood storage time. While comparing the group with average storage of blood≥14 day and the group with average storage of blood 〈 14 days,nosocomial infection rates were 6. 3% and 4. 1%,respectively,organ failure were 2. 8% and1. 4%,respectively,and mortality rates were 9. 6% and 6. 5%,respectively. Conclusion Nosocomial infection rates,mortality rates and organ failure in the group of patients transfused with blood storage time≥14 days are higher than the group of patients transfused with blood storage 〈 14 days. Therefore,critically ill ICU patients are recommended to be transfused with blood of storage time 〈 14 days.