输血治疗传统观念的变革与更新PPT.ppt

输血治疗传统观念的变革与更新;主要内容;人类输血简史;. Animal to human --- Jean Denis , 1667 . Human to human --1818, James Blundell -- 1900 The elucidation of the ABO blood group system by Landsteiner -- 1914 Lewisohn - used citrate -- 1940 Landsteiner and Wiener, in, describe Rh typing;成分输血的简史;减少和预防输血不良反应和并发症;现代成分输血的主要趋势;询证输血医学新观念;Crit Care Med 2009 Vol. 37, No. 12. 3124;败血症患者要求较高Hb水平的适应证不包括支持目的;FFP适应证不包括抗感染输注FFP不能作为支持疗法;重症患者输注红细胞导致的不良转归;;;;;;Analysis of 24,112 enrollees in 3 large international trials of patients with acute coronary syndromes Association between transfusion and outcome Cox proportional hazards modeling Main outcome = 30 day mortality;Blood Transfusion and Clinical Outcome in Acute Coronary Syndrome; 研究对象;;;15,592 Cardiovascular operations Infection endpoints bacteremia, SSI 55% of pts received PRBCs, 21% plts, 13% FFP, 3% cryoprecipitate Increased RBC tx associated with increased infection (p 0.0001), confirmed by logistic regression analysis（回归分析）.;Effect of Blood Transfusion on Long-Term SurvivalAfter Cardiac Operation;;Methods We enrolled 838 critically ill patients who had hemglobin concentrations of less than 9.0 g /dl and randomly assigned 418 patients to a restrictive strategy of transfusion, in which red cells were transfused if the hemoglobin concentration dropped below 7.0 g /dl and hemoglobin concentrations were maintained at 7.0 to 9.0 g /dl, and 420 patients to a liberal strategy, in which transfusions were given when the hemoglobin concentration fell below 10.0 g /dl and hemoglobin concentrations were maintained at 10.0 to 12.0 g /dl. Results Overall, 30-day mortality was similar in the two groups (18.7 percent vs. 23.3 percent, P=0.11). The mortality rate during hospitalization was significantly lower in the restrictive-strategy group (22.2 percent vs. 28.1 percent, P=0.05). ;患者输注红细胞导致的不良转归机制;;