急性上消化道出血患者临床输血策略回顾性分析

A retrospective analysis of clinical transfusion Strategies in patients with acute upper gastrointestinal bleeding

目的通过回顾性分析我院急性上消化道出血(AUGIB)患者临床输血实践中采用的输血阈值,评估限制性输血策略在急性上消化道出血患者中的普遍性和实用性。方法选取2020年7月—2022年6月在我院临床诊断为AUGIB并输注红细胞的患者为研究对象,调查输血患者采用的血红蛋白阈值的频率,并根据输血Hb阈值分为限制性输血组(输血Hb阈值为70 g/L,合并冠心病时为80 g/L)和非限制性输血组,比较两组患者预后之间的差异。结果384例输血AUGIB患者中,62.0%的患者采用Hb 70 g/L输血阈值,32.8%的患者采用70~80 g/L阈值,3.6%的患者采用80~90 g/L阈值,仅有1.6%的患者采用了Hb≥90 g/L的宽松输血策略;384例输血患者采用的输血策略以限制性输血为主,占比73.4%,在合并冠心病亚组患者中采用限制输血策略的的比例高达88.5%;384例患者中采用非限制性输血策略的患者仅为26.6%。限制性输血组患者住院期间再出血率为4.6%,非限制性输血组为10.8%,两组患者之间的差异有统计学意义(P=0.027);限制性输血组患者住院期间全因死亡率为5.3%,非限制性输血组为5.9%,两组患者死亡率之间的差异无统计学意义(P=0.830)。384例患者中有54例患者在输血后未能达到目标Hb值,存在输血不足的风险,占比14.3%,且均为限制性输血组患者;12.5%的患者在出院前Hb浓度低于目标Hb值,48例输血不足的患者中45例为限制性输血组患者。结论限制性输血策略已被广泛应用于AUGIB患者的临床输血实践中,具有良好的安全性和实用性。在避免过度输血的同时,也应对限制性输血带来的输血不足的风险重新加以关注。

Objective By retrospectively analyzing the transfusion threshold used in the clinical transfusion practice for acute upper gastrointestinal bleeding(AUGIB)patients admitted to our hospital,we evaluated the prevalence and utility of restrictive transfusion strategies for such patients.Methods Patients diagnosed with AUGIB and transfused with red blood cells in our hospital from July 2020 to June 2022 were selected as research subjects.The frequency of the hemoglobin(Hb)threshold used in the transfusion patients was investigated.According to the Hb threshold of blood transfusion,the patients were divided into a restrictive transfusion group(the hemoglobin threshold for transfusion was 70 g/L,and 80 g/L in the patients with coronary heart disease)and a non-restrictive transfusion group.Then,the differences in clinical outcomes between the two groups were compared.Results Among the 384 transfusion patients,Hb 70g/L transfusion threshold was used in 62.0%,70~80 g/L threshold in 32.8%,80~90 g/L threshold in 3.6%,and the liberal transfusion strategy of Hb≥90g/L in only 1.6%.The main transfusion strategy for 384 patients was restrictive transfusion,accounting for 73.4%,and the ratio was up to 88.5%in the subgroup of patients with coronary heart disease;the non-restrictive transfusion strategy was taken only in 26.6%of 384 patients.The rate of re-bleeding during hospitalization was 4.6%in the restrictive transfusion group,and 10.8%in the non-restrictive transfusion group,with the difference between the two groups being statistically significant(P=0.027).All-cause mortality during hospitalization was 5.3%in the restrictive transfusion group,and 5.9%in the non-restrictive transfusion group;there was no significant difference in mortality between the two groups(P=0.830).Totally 54 of 384(14.3%)patients failed to reach the target Hb value after transfusion and were at risk of undertransfusion,all of whom were in the restrictive transfusion group.12.5%of patients had Hb concentrations below the target Hb value before discharge,and 45 of the 48 undertransfusion patients were in the restrictive transfusion group.Conclusion The restrictive transfusion strategy widely used in the clinical transfusion practice for AUGIB patients is safe and practicable.While avoiding over-transfusion,we should also be alert on the risk of undertransfusion stemming from the restrictive transfusion strategy.