评估危重患者限制性输血的临床结果

目的 评估危重患者限制性输血的临床结果.方法 选择2008年1月1日至2011年1月1日于本院ICU病房治疗成年患者167例为研究对象.纳入标准:于ICU病房停留时间超过3 d;排除标准:急性冠状动脉综合征、缺血性脑卒中、急性出血、既往输血史和孕妇病例.限制性输血适应症指血红蛋白含量≤7 g/d的病例.结果 APACHE II评分为28.9±6.5,基线血红蛋白含量(10.6±2.2)g/dl.进入ICU第28 d,血红蛋白含量为(8.2±1.3)g/dl,较进入前显著降低(P＜0.001).59例予输血治疗,接受输血患者病死率(61.1％)显著高于未接受输血患者(48.6％)(P=0.03)

Assessment of the Clinical Outcomes of Critically ill Patients with Restrictive Transfusion

Objective To evaluate the clinical outcomes of critically ill patients with restrictive transfusion. Methods 167 adults who admitted to the ICU over 72 hours were included, which excepted those with acute coronary syndrome, ischemic stroke, acute hemorrhage, prior transfusion. The restrictive strategy consisted of transfusion indicated when hemoglobin levels were less than or equal to 7.0 g/dl. Results The acute physiology and chronic health evaluation Ⅱ（APACHE Ⅱ} score was 28.9±6.5. The baseline hemoglobin level was 10.6±2.2 g/dl and on day 28, it was 8.2±1.3 g/dl（P〈0. 001）. Transfusions were administered to 350,% of the patients. In the transfusion group, 61.1 % did not survive, versus 48.6 % in the non-transfusion group（ P= 0.03 ）. Transfusion was an independent risk factor for mortality（P= 0. 011;OR： 2.67; 95 % CI= 1.25 to 5.69）. ICU stay and hospital stay were longer in the transfusion group（20. 0 d versus 8. 0 d; P〈0. 001; and 24. 0 d versus 14. 0 d; P = 0. 002）, respectively. Conclusions In critically ill patients, there was a reduction in hemoglobin with increasing length of ICU stay. Moreover, transfusion was associated with worse prognoses.