张循善输血治疗传统观念的变革与更新XXXX省医学会.pptxVIP

输血治疗传统观念的变革与更新;主要内容;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.;Effect of Blood Transfusion on Long-Term SurvivalAfter Cardiac Operation;患者输注红细胞导致的不良转归机制;;;??究结果;Immune Effects of Blood;;手术切口愈合紊乱诊断标准;underwent laparotomy（剖腹术） underwent gastrectomy （胃切除） underwent gastroduodenostomy（胃十二指肠吻合术） CONCLUSIONS: Blood transfusions increased the incidence of anastomotic abscess（脓肿） and impaired anastomotic wound healing. ; 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;Colorectal Dis.2007V9N4:362-7 ;;“缺多少血，补多少血”与“失多少血，补多少血”是否合理？？;英国输血一般原则;RBCs should be administered as single units for most operative and inpatient indications (transfuse and reassess strategy) except for ongoing blood loss with hemodynamic instability. Tx decisions are clinical judgments that should be based on the overall clinical assessment of the individual patient. Transfusion decisions should not be based on laboratory parameters alone. Routine premedication is not advised unless the patient h