作者投稿
专家审稿
编辑办公
邮件订阅
RSS
Blood Use in Surgical Patients with Red Blood Cell Transfusion of Over 20 Units during Single Hospital Stay
-
摘要:
目的 总结北京协和医院单次住院红细胞用量超过20 U外科手术患者的用血情况, 以探讨合理用血策略。 方法 2015年1月至10月北京协和医院外科手术患者单次住院红细胞用量超过20 U的患者27例, 收集其临床资料, 对围术期及术中成分输血情况和患者结局进行分析。 结果 27例患者中, 男性22例, 女性5例。27例患者围术期共输注血液制品红细胞867 U, 血浆124 800 ml, 血小板50治疗量。围术期红细胞用量20~29 U 15例(55.6%), 最高用量92 U。术中累计输注红细胞334 U, 占围术期总输注量的38.5%;术中输注血浆32 000 ml, 占围术期总输注量的25.6%。平均住院时间43 d, 其中住院时间 < 7 d者1例(2.3%), >60 d者3例(11.1%)。治疗后顺利出院患者16例(59.3%), 放弃治疗患者5例(18.5%), 死亡患者6例(22.2%)。 结论 术前评估及术前多科全面会诊对于输血决策及病情评估至关重要。术中遇到大量出血时应尽快采取止血措施, 根据出血量科学把握输血时机。同时应加强用血管理, 避免血液资源的浪费。 Abstract:Objective To assess the blood use in surgical patients with red blood cell(RBC) transfusion of over 20 U during single hospital stay in Peking Union Medical College Hospital (PUMCH) in order to help develop strategy for rational blood use. Methods We collected 27 surgical patients which received RBC transfusion of over 20 U during single hospital stay between January and October 2015 in PUMCH, and analyzed the data of these patients in aspects of baseline characteristics, blood use in perioperative period and during surgery, and treatment outcome. Results There were 22 males and 5 females in the 27 patients. A total of 867 U RBCs, 124 800 ml blood plasma, and 50 U platelets were transfused in them. Fifteen patients (55.6%) received 20~29 U RBCs in perioperative period, and the maximum volume of RBCs use per person was 92 U. Three hundred and thirty-four U RBCs were transfused during surgery, accounted for 38.5% of the total use; 32 000 ml blood plasma was transfused during surgery, accounted for 25.6% of the total volume used in perioperative period. The mean length of hospital stay was 43 days, with 1 patient hospitalized for less than 7 days (2.3%) and 3 for more than 60 days (11.1%). Sixteen patients (59.3%) were discharged after successful treatment, 5 patients (18.5%) gave up treatment, and 6 patients died (22.2%). Conclusions It is very important to perform preoperative assessment and cross-department consultation for rational blood transfusion strategy and disease severity evaluation. In order to reduce the volume of blood transfusion, conducting prompt hemostasis in the cases of major bleeding during surgery and seizing the appropriate timing for blood transfusion is essential. Management of blood use should also be strengthened for better use of blood product. -
Key words:
- massive transfusion /
- department of surgery /
- operation
-
[1] Stankovic B, Stojanovic G.Chemotherapy analysis in massive transfusion syndrome[J]. Med Pregl, 2016, 69:37-43. doi: 10.2298/MPNS1602037S [2] 孙桂琴, 徐敏, 王海林, 等.手术病人大量输注全血和成分血的对比分析[J].中国输血杂志, 2004, 17:102-103. http://www.cnki.com.cn/Article/CJFDTotal-BLOO200402014.htm [3] Baysinger K, Barnett ME, Ott M, et al.What's in the Box? The effectiveness of a low-volume massive transfusion protocol[J]. Am Surg, 2016, 82:602-607. doi: 10.1177/000313481608200725 [4] 岳丽萍, 宋桂荣, 李艳红, 等.异体输血的替代方法[J].中外健康文摘, 2011, 8:119-120. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zwjkwz201111097 [5] 杨美英, 马丽波.围手术期自体输血与异体输血对免疫球蛋白的影响及对策[J].内蒙古医学杂志, 2013, 45:317-319. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=nmgyxzz201303020 [6] 杨孝顺, 安梅, 阮光萍, 等.冷沉淀在临床外科手术中的应用[J].中国输血杂志, 2005, 18:255-257. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgsxzz200503046 [7] 付朝宏, 曾小玲, 何杏兰, 等.骨外伤病人急性失血后的成分输血与应用[J].中医正骨, 2002, 14:19-20. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zyzg200209012 [8] 汪群英.外科手术中新鲜冰冻血浆应用236例[J].郑州大学学报:医学版, 2004, 39:130-132. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=henanykdx200401047 [9] 吴文蕾, 李升, 韩冰, 等.原发性纤维蛋白原溶解症致牙龈出血的临床分析(附病例报告)[J].口腔医学研究, 2007, 23:353-354. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=kqyxzh200703043 [10] Fligor SC, Hamill ME, Love KM, et al.Vital signs strongly predict massive transfusion need in geriatric trauma patients[J]. Am Surg, 2016, 82:632-636. doi: 10.1177/000313481608200730 [11] Brooke M, Yeung L, Miraflor E, et al. Lactate predicts massive transfusion in hemodynamically normal patients[J]. J Surg Res, 2016, 204:139-144. doi: 10.1016/j.jss.2016.04.015 [12] Rau CS, Wu SC, Kuo SC, et al. Prediction of Massive Transfusion in Trauma Patients with Shock Index, Modified Shock Index, and Age Shock Index[J].Int J Environ Res Public Health, 2016, 13:E683. doi: 10.3390/ijerph13070683 [13] 郑艳, 尹杨, 么春艳.手术室护士在术中静脉输血输液的配合体会[J].局解手术学杂志, 2004, 13:359. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgjjssxzz200405055 [14] 腾方, 陈方祥.大量输血及其并发症[J].重庆医学, 2007, 36:2502-2504. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=cqyx200724019 [15] Aboudara MC, Hurst FP, Abbott KC, et al. Hyperkalemia after packed red blood cell transfusion in trauma patients[J]. J Trauma, 2008, 64(2 Suppl):86-91. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=795e2edb20d80a1245489e13b11c48e3 [16] Donaldson MD, Seaman MJ, Park GR. Massive blood transfusion[J]. Br J Anaesth, 1992, 69:621-630. doi: 10.1093/bja/69.6.621 -
点击查看大图
计量
- 文章访问数: 177
- HTML全文浏览量: 54
- PDF下载量: 6
- 被引次数: 0
下载:
