限制性输血策略在临床急诊输血指导中的应用价值

APPLICATION VALUE OF RESTRICTIVE TRANSFUSION STRATEGY IN CLINICAL EMERGENCY TRANSFUSION GUIDANCE

目的 探讨限制性输血策略在临床急诊输血指导中的应用价值。方法 选取2018年1月—2019年在该院行急诊创伤手术患者110例,根据输血策略分为观察组(n=60)和对照组(n=50),观察组给予限制性输血策略,对照组给予开放型输血策略,观察二组输血量、不良反应等。结果 观察组输血量为(2.40±0.78)U,明显低于对照组(P<0.05);观察组和对照组手术前后心率(HR)和平均动脉压(MAP)比较差异无统计学意义(P>0.05);观察组术后中心静脉压(CVP)为(8.21±1.21)mmHg,明显高于对照组(P<0.05);观察组术后颈静脉血氧饱和度(SjvO2)为(77.80±6.80)%,明显高于对照组(P<0.05),而动脉-颈内静脉血氧含量差(Da-jvO2)和脑氧摄取率(CEO2)分别为(31.28±8.83)ml和(25.59±5.52)%,明显低于对照组(P<0.05);观察组术后左室射血分数(LVEF)和左室舒张早期/舒张晚期充盈的充盈峰(E/A)分别为(67.10±8.04)%和(1.66±0.30),明显高于对照组(P<0.05);观察组和对照组术后第一秒用力通气量占预计值比例(FEV1%)、用力肺活量占预计值比例(FVC%)比较差异无统计学意义(P>0.05)。观察组不良反应发生率为6.67%,明显低于对照组(P<0.05)。结论 限制性输血策略在临床急诊输血指导中的有较好的应用价值,值得临床使用。

Objective To explore the application value of restrictive transfusion strategy in clinical emergency transfusion guidance. Methods From January 2018 to 2019,One hundred and ten patients underwent emergency trauma surgery in our hospital, according to the strategy of blood transfusion, the patients were divided into observation group(n=60) and control group(n=50),the observation group was given limited transfusion strategy, and the control group was given open transfusion strategy, the amount of blood transfusion and adverse reactions and so on were observed. Results The blood transfusion volume of the observation group was(2.40 ± 0.78)U,which was significantly lower than that of the control group(P<0.05);There were no significant difference in heart rate(HR) and mean arterial pressure(MAP) before and after surgery between the two groups(P<0.05);The postoperative central venous pressure(CVP) of the observation group was(8.21 ± 1.21) mmHg, significantly higher than that of the control group(P<0.05);The postoperative cervical venous oxygen saturation(SjvO_2) in the observation group was(77.80±6.80) %,which was significantly higher than that in the control group(P<0.05),while the difference in artery-jugular venous oxygen content(Da-jvO_2) and brain oxygen uptake rate(CEO_2) were(31.28±8.83) ml and(25.59±5.52) %,which were significantly lower than that in the control group(P<0.05);The left ventricular ejection fraction(LVEF) and the filling peak(E/A) of left ventricular early diastolic/late diastolic filling in the observation group were(67.10 ± 8.04)% and(1.66 ± 0.30),respectively, which were significantly higher than those in the control group(P<0.05);There was no significant difference between the observation group and the control group in the proportion of forced ventilation to the predicted value(FEV1%) and forced vital capacity to the predicted value(FVC%) in the first second after operation(P<0.05).The incidence of adverse reactions in the observation group was 6.67%,which was significantly lower than that in the control group(P<0.05). Conclusion The restrictive transfusion strategy has a good application value in clinical emergency blood transfusion guidance and is worth clinical use.