目的探讨严重感染患者输血与否的血红蛋白浓度参考标准。方法回顾性分析2010年4月~2015年6月重庆市綦江区人民医院收治的严重感染贫血患者984例的临床资料。根据输血采用的不同的血红蛋白浓度标准将患者分为限制性输血组558例和开放性输血组426例。限制性输血组在血红蛋白浓度<70 g/L时予以输注红细胞1 U,并使其维持在70~90 g/L,开放性输血组在血红蛋白浓度<100 g/L时予以输注红细胞1 U,并使其维持在100~120 g/L。观察两组输血情况,分析两组输血前后氧动力学与代谢监测指标的变化,如氧输送(DO_2)、氧耗量(VO_2)、氧摄取率(O_2ER)、中心性静脉血氧饱和度(Scv O_2)。采用序贯器官衰竭估计评分(SOFA)评价器官功能衰竭情况。记录两组不同输血方案对预后的影响。结果限制性输血组红细胞输注量[(3.85±1.41)U]显著低于开放性输血组[(6.95±2.97)U],差异有统计学意义(P<0.05)。输血前,限制性输血组血红蛋白浓度显著低于开放性输血组(P<0.05),输血后两组差异亦有统计学意义(P<0.05)。输血后,两组DO_2、VO_2均较输血前显著升高,O_2ER、ScvO_2、血乳酸水平显著降低,差异均有统计学意义(P<0.05)。但是两组输血后上述各项指标差异无统计学意义(P>0.05)。两组患者住院期间SOFA各系统评分及总分比较,差异无统计学意义(P>0.05)。两组30 d病死率、心力衰竭发生率比较差异均无统计学意义(P>0.05),但限制性输血组住院期间病死率(36.38%)显著低于开放性输血组(40.14%),差异有统计学意义(P<0.05)。结论严重感染患者在血红蛋白浓度<70 g/L时输注红细胞,并使其维持在70~90 g/L,有利于减少不必要的输血,且能满足机体代谢的需要,并改善预后。 Objective To investigate the reference standard of hemoglobin concentration in patients with severe infection or not. Methods The clinical data of 984 patients with severe anemia who were admitted to Qijiang District People’s Hospital of Chongqing from April 2010 to June 2015 were retrospectively analyzed. Patients were divided into 558 cases of restricted transfusion group and 426 cases of open transfusion group according to the different hemoglobin concentration standards used for transfusion. In the restricted blood transfusion group, 1 U of red blood cells were transfused when the hemoglobin concentration was less than 70 g / L and maintained at 70-90 g / L. In the open transfusion group, red blood cells 1 were transfused when the hemoglobin concentration was less than 100 g / L U, and maintain it at 100 ~ 120 g / L. The blood transfusion of the two groups was observed. The changes of oxygenation and oxygen metabolism before and after transfusion were analyzed, such as oxygen delivery (DO_2), oxygen consumption (O_2ER), central venous oxygen saturation ( Scv O_2). Sequential organ failure assessment score (SOFA) was used to evaluate organ failure. The effects of two different transfusion regimens on prognosis were recorded. Results The amount of erythrocyte transfusion in the restricted transfusion group was significantly lower than that in the open transfusion group [(6.95 ± 2.97) U] (P <0.05). Before transfusion, hemoglobin concentration in the restricted blood transfusion group was significantly lower than that in the open transfusion group (P <0.05). There was also a significant difference between the two groups after transfusion (P <0.05). After transfusion, DO 2 and VO 2 in both groups were significantly higher than those before transfusions, and the levels of O 2ER, ScvO 2 and blood lactate were significantly decreased (all P <0.05). However, there was no significant difference between the above two indexes after transfusion (P> 0.05). There was no significant difference in SOFA scores and scores between the two groups during hospitalization (P> 0.05). There was no significant difference in the incidence of 30-day mortality and heart failure between the two groups (P> 0.05). However, the mortality rate during hospitalization in the restricted transfusion group (36.38%) was significantly lower than that in the open transfusion group (40.14%), There was statistical significance (P <0.05). Conclusion In patients with severe infection, erythrocytes are infused at a hemoglobin concentration of <70 g / L and maintained at 70-90 g / L, which helps to reduce unnecessary blood transfusions and meet the needs of body metabolism and improve prognosis.