诊断性失血对重症消化道畸形患儿贫血和输血的影响

The effect of diagnostic blood loss on anemia and transfusion in children with severe gastrointestinal abnormality

目的探讨在使用新型密闭式采血系统和儿童采血管的情况下,诊断性抽血对重症消化道畸形患儿贫血和输血的影响。方法收集2018年12月至2019年3月我院小儿ICU收治的消化道畸形、住ICU时间≥7天的患儿临床资料,单因素和Logisitic多元回归分析患儿在住ICU期间发生贫血和输血的影响因素。结果61例患儿均采用新型密闭式采血系统和儿童采血管。在住ICU期间,患儿的平均抽血量为(36.0±19.5)ml,每日抽血量为(3.6±1.7)ml/d校正体重后为(1.2±1.1)ml/(kg·d)。单因素和Logisitic多元回归分析结果显示抽血量>36.0 ml、单位体重每日抽血量>1.2 ml的患儿更易出现新发贫血或贫血程度加重;住ICU期间小儿器官功能衰竭评分最大值>5分、每日抽血量>3.6 ml的患儿入ICU 48小时后更易输血。结论新型密闭式采血系统和儿童采血管可减少患儿的诊断性失血量,但诊断性抽血仍是重症消化道畸形患儿发生贫血和输血事件的重要原因之一。尽量减少诊断性抽血和尽早营养干预,或许能减少重症消化道畸形患儿医源性贫血的发生。

Objective To evaluate whether diagnostic blood sampling could lead to anemia and the consequent blood transfusion in children with severe gastrointestinal abnormality when using a new closed blood collection system and pediatric phlebotomy tubes.Methods Clinical data of children with digestive tract malformation in ICU for≥7 days from December 2018 to March 2019 in our hospital were collected.Univariate and logisitic multiple regression analyses were used to analyze the influencing factors of anemia and blood transfusion during the children's stay in the ICU.Results Sixty-one children were treated with a new closed blood collection system and children's blood collection tubes.In the ICU,the average volume of blood drawn from children was(36.0±19.5)ml,and the daily volume of blood drawn was(3.6±1.7)ml/d(1.2±1.1 ml/(kg·d)after weight adjustment).Univariate analysis and logisitic regression analysis showed that children with volume of drawn blood>36.0 ml and volume of drawn blood>1.2 ml per unit weight per day was more likely to have new anemia or increased anemia.Children with the maximum score of organ failure>5 and daily volume of drawn blood>3.6 ml were more likely to receive blood transfusion after 48 hours in the ICU.Conclusion The volume of diagnostic blood loss is decreased after use of a new closed blood collection system and pediatric phlebotomy tubes.However,diagnostic blood loss is still one of the main reasons causing anemia and the need of blood transfusions in the ICU among children with severe gastrointestinal abnormality.Minimizing blood draw and early nutritional intervention may further reduce the incidence of iatrogenic anemia in these sick children.