限制性采血对ICU患者血红蛋白及预后的影响

Effect of restricted blood sampling on hemoglobin changes and the prognosis in ICU patients

目的探讨限制性采血策略对危重症患者血红蛋白及预后的影响。方法分析南京中医药大学附属中西医结合医院重症监护病房2019年1月1日至2020年10月31日期间住院患者,纳入住院时间≥7 d,年龄≥18岁,排除手术、活动性出血疾病及血液净化患者,随机分为限制组和对照组,记录住院期间患者首日急性生理与慢性健康状况评分(APACHEⅡ)及序贯器官衰竭评分(SOFA),入院时和入院后第1、3、7天血红蛋白(Hb)值,贫血严重程度及发生率,日均采血量,ICU住院时间,机械通气时间,血管活性药物使用时间以及预后,对相关数据进行统计分析。结果纳入统计患者共191人,限制组109人,对照组82人;与对照组比较,限制组APACHEⅡ评分、SOFA评分、ICU住院时间、血管活性药物使用时间和患者预后差异均无统计学意义(P>0.05),限制组机械通气时间较对照组缩短[d:6.0(3.8~9.0)vs.4.0(2.0~7.0),P<0.05];两组患者入院后Hb水平呈不同程度下降,第1天差异无统计学意义(P>0.05),而在第3、7天差异有统计学意义[第3天(g/L):100.3±11.1 vs.106.3±11.1,第7天(g/L):99.4±11.8 vs.109.5±10.9,P<0.05]。结论ICU患者出现医源性贫血的概率极高,以轻度贫血为主,限制性采血不能改善患者血管活性药物使用时间、ICU住院时间及预后,但可能缩短患者机械通气时间。

Objective To investigate the impact of restricted blood sampling on hemoglobin changes and the prognosis in critically ill patients in Intensive Care Unit(ICU).Methods To analyze the inpatients in the ICU of the Affiliated Hospital of Integrated Traditional Chinese and Western Medicine,Nanjing University of Chinese Medicine from January 1 st,2019 to October 31 th,2020.Inclusion criteria included the hospitalization time≥7 days,age≥18 years old,the patients without the surgery,active bleeding and blood purification.The patients were randomly divided into restricted sampled group and control group,APACHEⅡscore and SOFA score on the first day of admission,hemoglobin value on admission and on the 1 st,3 rd,and 7 th day after admission,the severity and incidence of anemia,daily blood sampled volume,ICU hospitalization time,time of mechanical ventilation,usage time of vasoactive drugs,and the prognosis were recorded and statistically analyzed.Results A total of 191 patients were included,they were randomly divided into the restricted sampled group of 109 patients and control group of 82 patients.Compared with the control group,there were no significant differences in APACHEⅡand SOFA scores,ICU hospitalization time,vasoactive drug usage time,and patient prognosis in the restricted sampled group(P>0.05).The mechanical ventilation time was shortened,and the comparison between the two groups was statistically significant[d:6.0(3.8-9.0)vs.4.0(2.0-7.0),P<0.05].The hemoglobin level of the patients decreased to varying degrees after admission,and there was no significant difference in the declining level of hemoglobin on the first day.However,the comparison between the two groups on the third and seventh day was statistically significant[the third day(g/L):100.3±11.1 vs.106.3±11.1,the seventh day(g/L):99.4±11.8 vs.109.5±10.9,P<0.05].Conclusions ICU patients have a very high probability of iatrogenic anemia,mainly mild anemia.Restricted blood sampling can not improve the patient’s vasoactive drug usage time,ICU hospitalization time and prognosis,but may shorten the patient’s mechanical ventilation time.