The best strategy for red blood cell transfusion in severe burn patients,restrictive or liberal: A randomized controlled trial

IntroductionAlthough blood transfusion is common in burns, data are lacking in appropriate transfusion thresholds. It has been reported that a restrictive blood transfusion policy decreases blood utilization and improves outcomes in critically ill adults, but the impact of a restrictive blood transfusion policy in burn patients is unclear. We decided to investigate the outcome of decreasing the blood transfusion threshold.Material and methodsEighty patients with TBSA > 20% who met our inclusion criteria were included. They were randomly divided into control and intervention groups. The intervention group received packed cells only when Hemoglobin declined to less than 8 g/dL at routine laboratory evaluations. While the control group received packed-cell when hemoglobin was declined to less than 10 g/dl. The total number of the received packed cell before, during and after any surgical procedure was recorded. The outcome was measured by the evaluation of the infection rate and other complications.ResultThe mean hemoglobin level before transfusion was 7.7 ± 0.4 g/dL in the restrictive group and 8.8 ± 0.7 g/dL in the liberal group. The mean number of RBC unit transfusion per patient in the restrictive group was significantly lower than the traditional group (3.28 ± 2.2 units vs. 5.9 ± 3.7 units) (p-value = 0.006). The total number of RBC transfused units varied significantly between the two groups (p-value = 0.014). The number of transfused RBC units outside the operation room showed a significant difference between groups (restrictive: 2.8 ± 1.4 units vs. liberal: 4.4 ± 2.6 units) (p = 0.004). We did not find any significant difference in mortality rate or other outcome measures between groups.ConclusionApplying the restrictive transfusion strategy in thermal burn patients who are highly prone to all kinds of infection, does not adversely impact the patient outcome, and results in significant cost savings to the institution and lower rate of infection. We conclude that the restrictive transfusion practice during burn excision and grafting is well tolerated and effective in reducing the number of transfusions without increasing complications.Clinical Trial Registration ReferenceIRCT20190209042660N1.     

库存全血保存期间血液流变学特性的变化

目的 观察库存全血保存期间血液流变学特性的变化。方法 随机选择20例献血者．常规采血保存，分别于采集后10个时间点：2h,24h、3d、5d、7d、10d、14d、21d、28d、33d检测全血粘度（高切、中切、低切）及红细胞压积。结果 库存全血保存24h后高、中切粘度的升高有显著性（P〈0．05），14d后低切粘度的升高也有显著性（P〈0．05），但红细胞压积的变化无显著性。结论库血随存放时间的延长，血液流变学特性有显著性改变。     

Perioperative specific management of blood volume loss in craniosynostosis surgery

Accurate assessment and replacement of blood loss and fluid–electrolyte deficit during craniosynostosis repair is difficult owing to patient size and the diversity of surgical technique. Forty-three patients undergoing primary craniosynostosis repair over a 10-year period were studied retrospectively to determine blood loss and fluid deficit and to assess blood transfusion practices during both intraoperative and postoperative periods. Blood loss was calculated on the basis of estimated red cell mass (ERCM) and fluid-electrolyte imbalance was investigated with blood samplings. Blood transfusion was considered appropriate if the postoperative or posttransfusion ERCM was within 12% of the preoperative value. Estimated fluid requirement (EFR) was used in 4 ml kg^–1 h^–1 except for neonates. Intraoperatively, 80% of all patients were appropriately managed with respect to blood transfusion and EFR. Postoperatively only 20% of the patients receiving transfusions were transfused appropriately. In 23.3% of these patients (10/43) unexpected respiratory distress developed immediately after their recovery from the anesthesia. With the measurement of estimated blood volume and allowable blood loss, appropriate transfusion could be achieved for the successful treatment of the primary craniosynostosis. Received: 16 February 1998     

改良超滤对婴幼儿心脏手术输血的影响

目的　观察改良超滤技术在婴幼儿体外循环心血管手术中对输血及术后出血的影响。方法　 6 0例接受体外循环下心血管手术的先天性心脏病患儿 ,均分为对照组 (不接受任何超滤 )、常规超滤组 (CUF组 )和改良超滤组 (MUF组 )。观察术中库血用量、血浆用量、血球压积的变化及术后2 4h出血量 ,并用SSPS/PC进行统计学处理。结果　MUF组库血用量、血浆用量、术后 2 4h出血量显著低于对照组和CUF组 (P <0 0 1) ,且滤出水量明显多于CUF组 (P <0 0 1)。结论　在婴幼儿心血管手术中 ,改良超滤可有效排出体内水分 ,提高血球压积 ,明显减少输血及术后出血 ,是节约用血的重要手段之一。     

广西百色地区肝病患者及受血者HCV感染现状调查

笔者应用ＥＬＩＳＡ法对广西百色地区１７９例各类肝病患者及４１例受血者血清进行了抗－ＨＣＶ检测。结果各类肝病抗－ＨＣＶ阳性率为１７．９％，受血者抗－ＨＣＶ阳性率为３１．７％。在急性肝炎（急肝）、慢性肝炎（慢肝）、肝硬化和肝癌中，抗－ＨＣＶ阳性率各为４．３％（１／２３）、１２．８％（１０／７８）、２８．６％（１２／４２）和２５．０％（９／３６）。抗－ＨＣＶ阳性率有随肝病慢性比而增高的趋势，肝硬化的抗－ＨＣＶ阳性率明显高于急肝或慢肝（Ｐ＜０．０５），而肝癌的抗－ＨＣＶ阳性率与急肝或慢肝相差不显著（Ｐ＞０．０５或０．１），且发现ＨＢｓＡｇ阴性肝病者的抗－ＨＣＶ阳性率明显高于ＨＢｓＡｇ阳性患者（Ｐ＜０．５），肝病患者抗－ＨＣＶ的检出率与ＡＬＴ活性无关（Ｐ＞０．０５）。在受血者中，抗－ＨＣＶ的检出率与受血次数、ＡＬＴ活性关系非常密切。因此，加强对ＨＣＶ的检测是当前预防输血后肝炎的紧迫任务。     

急性肺水肿是输液相关性死亡的主要原因

目的探讨输液相关性死亡的病理学特点及死亡原因.方法对1990年～2001年间医疗纠纷尸检档案中28例输液相关性死亡的资料进行分析.结果输液过程中死亡以中老年男性为主,输液相关死亡多发生在基层医疗单位内科性质科室.死亡多发生在输液4 h内,绝大多数患者在临死前有呼吸困难的表现.尸检发现死者大体呈溺死肺样改变,重量增加1～2倍.结论输液引起死亡的原因以急性肺水肿为主,其次为输液过多致动脉瘤破裂.     

四类抗感染药物不良反应相关因素的探讨与分析

目的：使输液疗法中药物不良反应降到最低限度，使患者获得安全、有效的治疗，同时，也是对有限药物资源的维护。方法：对用四类抗感染药物出现不良反应91例患者行减慢输液速度、平卧、松解领扣、按合谷穴、心理护理、保暖、进饮食等处置。结果：91例药物不良反应，有89例顺利完成输液治疗，2例无效，更换药物。结论：有责任感，加强观察护理及时发现患者反应前驱症状，迅速采取有效措施，会取得满意效果。     

Palliative treatment at home for patients with haematological disorders

 Supportive treatment of patients with haematological disorders mainly takes the form of transfusions of blood and platelets, and sometimes palliative chemotherapy is given. Most patients are treated in hospital or at the outpatient clinic. However, it is often difficult for the patients to arrange to come to the hospital, as they need transport by ambulance or taxi and sometimes a relative to help them. Throughout 1996 we offered such patients supportive treatment at home. A nurse was employed on the project, who was supplied with a car and a mobile telephone. Treatment was given at home. In all, 17 patients were treated, with a total of 90 blood and 40 platelet transfusions. At three visits chemotherapy was administered. No complications were seen, and the patients felt safe and content. We conclude that supportive treatment at home is safe and well accepted by patients and their relatives. In addition, the costs for transportation and hospital care of this patient group were reduced.