输血在危重外伤病人应用的研究.docVIP

精品论文 参考文献 输血在危重外伤病人应用的研究 1.四川省人民医院心内科;2.四川省人民医院ICU 610072 摘要：目的 通过研究2013年 4月20日在雅安地震中严重受伤被四川人民医院ICU收治的病人探讨输血应用、输血相关并发症及预后。方法 通过随访观察雅安地震中严重受伤群众1个月的预后的横断面回顾性研究，对象为ICU142名住院病人（62名男性和80名女性）。其中接受输血的有75人（52.8%，55名非活动性出血患者，20名活动性出血患者）。结果 75名住院患者在输血前血红蛋白平均在80.8plusmn;14.7g/l，输血相关并发症的发生率在13.0%（14个并发症/108次输血），接受输血的患者在进入研究的第1、7、28天没有发现APACHE II评分的不同，包括平均动脉压、AST 肌酐值 氧合指数或者血红蛋白值。结论 1、ICU医生输血策略选择比外科医生更严谨2、当更严格的输血指征被采用时，就不会出现器官功能受损，并发症的发病率上升或预后恶化，所以需要进一步的研究来确定最优输血指征。 关键词：输血；重症监护室；icu；特护病房；地震；输血指征 [Abstract]Background The most severely injured victims of the earthquake that struck Yarsquo;an on April 20，2013 had been admitted to the intensive care unit of Sichuan XX Hospital.This study was conducted to evaluate the application of blood transfusion as well as the onset of transfusion-related complications and prognosis.Methods The cross-sectional retrospective study covering a 1-month period was conducted on 142 patients admitted to ICU. Results A total of 142 patients（62 male and 80 female）were included. Seventy-five of them（52.8%）had received at least one transfusion with a mean hemoglobin of 80.8plusmn;14.7g/L before each transfusion，and an incidence of transfusion-related complications of 13.0%（14 complications /108 transfusions）. Of the 55 non-active bleeding patients included in this study we found no difference in the APACHE II scores，mean arterial blood pressure，AST，creatinine level，oxygenation index or hemoglobin level on days 1，7 and 28 since admission；neither the transfusion frequency or the mean volume，or the incidence of transfusion-related complications，incidence of infectious complications，time with MV，and 28-day mortality. A statistically significant difference was found in hemoglobin level before each transfusion between two groups. Conclusions The strategy of transfusion is more liberal among surgeons than ICU doctors；no impaired organ functions，elevated incidence of complications or worsened prognosis were observed when a more restricted transfusion trigger is