张循善 输血治疗传统观念的变革与更新2012省医学会课件.pptVIP

输血治疗传统观念的变革与更新 安徽医科大学第一附属医院 张循善 主要内容 询证输血医学新观念 现代输血疗法的临床应用 询证输血医学新观念 输血作为重症患者的支持疗法没有询证依据 同种输血能够导致外科患者及重症患者不良转归 输血不能促进伤口愈合 “失多少血，补多少血”是过时、错误观念 重症患者输注红细胞导致的不良转归 From 571 articles screened, 45 met inclusion criteria In 42 of the 45 studies the risks of RBC transfusion outweighed the benefits; Seventeen of 18 studies, demonstrated that RBC transfusions were an independent predictor of death; Twenty-two studies examined the association between RBC transfusion and nosocomial infection; in all these studies blood transfusion was an independent risk factor for infection. RBC transfusions similarly increased the risk of developing multi-organ dysfunction syndrome (three studies) and acute respiratory distress syndrome (six studies). Marik PE, Corwin HL. Efficacy of red blood cell transfusion in the critically ill: a systematic review of the literature[J]. Crit Care Med. 2008;36(9):2667-2674 患者输注红细胞导致的不良转归机制 Storage lesion 库存红细胞2.3-DPG含量下降 Metabolic acidosis Altered oxygen carrying capacity 库存红细胞变形能力下降 库存红细胞携带NO能力减弱 Increased red cell death with increased age of blood (~30% dead) No improvement in oxygen utilization at the tissue level 同种输血的免疫负向调节作用 2001 and June 2005 we have performed a prospective observational study in 1553 elective and emergency patients who underwent median sternotomy for heart surgery. CONCLUSIONS: According to our results, the total amount of allogeneic blood transfused is a major factor contributing to sternal dehiscence （胸骨裂开）regardless of other risk preconditions. European Journal of Anaesthesiology: May 2006 - Volume 23 - Issue - p 1-2 英国输血一般原则 现代红细胞输注适应症和输注指征一 、慢性贫血 贫血时机体的反应* 慢性贫血的输血目的 提高血红蛋白水平，以保证组织供氧。因此应当输注红细胞即可，不应输注全血。 慢性贫血的输血原则 临床上输注红细胞主要是消除或减轻缺氧症状，只要将Hb水平提高到能保证足够的组织供氧即可，不需要通过输血将患者的Hb水平恢复到正常水平。..\红细胞保存\输血到HB正常水平不能改变患者的转归.PDF 人类耐受低Hb的能力 英国红细胞输注指南（2002年） Red Blood Cell Tr