严重创伤失血患者大量输血后血糖水平、多器官功能障碍综合征发生率和病死率的观察

目的：研究严重创伤失血患者大量输血对血糖水平、多器官功能障碍综合征（ MODS）发生率及病死率的影响,为严重创伤失血患者科学有效输血提供依据。方法回顾分析解放军94医院创伤急救中心2012年12月—2015年12月救治的严重创伤失血并输血患者391例的病历资料,将391例分为大量输血（24 h 内成年人输注红细胞悬液≥20.0 U 或0.3 U / kg 体重）组（n =156）和一般输血（24 h 内输血量﹤大量输血标准）组（ n =235）,观察并统计两组输血前空腹血糖（GLU0）、输血后3 d 空腹血糖（GLU3）、GLU3/ GLU0、MODS 发生率和病死率。结果大量输血组GLU3、GLU3/ GLU0、MODS 发生率均明显高于一般输血组（ P ﹤0.01）,两组病死率差异无统计学意义（ P ﹥0.05）。结论大量输血并不能有效降低严重创伤患者的 MODS 发生率及病死率,反而可能因促进血糖应激水平升高而引发MODS,导致病死率升高。

Clinical Observation of Blood Glucose Level,MODS Incidence and Fatality Rates of Severe Trauma and Hemor-rhage Patients after Massive Transfusion

Objective To investigate the effects on blood glucose level,incidence and fatality rates of multiple organ dysfunction syndrome(MODS)in severe trauma and hemorrhage patients after massive transfusion in order to pro-vide evidence of effective transfusion. Methods Clinical data of 391 severe trauma and hemorrhage patients after blood transfusion during December 2012 and December 2015 was retrospectively analyzed. The patients were divided into mas-sive transfusion group(adult infusion of red cell suspension≥20. 0 U or 0. 3 U / kg body weight within 24 h,n = 156) and moderate transfusion group(blood transfusion volume ﹤ massive transfusion standard within 24 h,n = 235). Glucose levels before the blood transfusion(GLU0 ),and glucose levels 3 d after the blood transfusion(GLU3 ),GLU3 / GLU0 val-ues and incidence and fatality rates of MODS were observed and evaluated in the two groups. Results The values of GLU3 ,GLU3 / GLU0 and incidence rate of MODS in massive transfusion group were significantly higher than those in mod-erate transfusion group(P ﹤ 0. 01). There was no significant difference in fatality rate in the two groups( P ﹥ 0. 05). Conclusion The massive transfusion can not effectively decrease the incidence and fatality rates of MODS in severe trau-ma and hemorrhage patients,on the contrary,massive transfusion can induce MODS and increase fatality rate by promo-ting stress level of blood glucose.