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目的:探讨限制性输血对ICU患者临床转归的影响。方法:选择接受红细胞输血治疗的271例ICU患者作为研究对象。根据不同输血策略将患者分为开放性输血组(输血前Hb<100g/L)与限制性输血组(输血前Hb<70g/L)。收集2组患者的年龄、性别、疾病分布等一般资料;对2组患者进行急性生理与慢性健康状况评分Ⅱ(APACHEⅡ评分)和多器官功能障碍评分(MODS);记录2组ICU内输血情况及Hb变化情况;观察2组患者3周内病死率、住院期间病死率,以及重症感染、肺水肿、心力衰竭发生率等。结果:12组在平均年龄、APACHEⅡ评分、疾病分布等方面无明显差异(P>0.05);2限制性输血组住院期间每例平均输注红细胞(4.5±3.7)U,低于开放性输血组的(6.8±4.6)U,差异有统计学意义(P<0.05)。限制性输血组入院时Hb、ICU内输红细胞前后Hb、出院时Hb均低于开放性输血组(P<0.05);3限制性输血组3周内病死率与住院期间病死率低于开放性输血组,但差异无统计学差异(P>0.05),限制性输血组重症感染、肺水肿、心力衰竭的发生率及MODS评分、≥3个器官衰竭等方面明显低于开放性输血组(P<0.05)。结论:对ICU患者实施限制性输血策略减少临床不必要的输血,节约宝贵的血液资源,降低输血并发症的发生率。
Objective: To investigate the impact of restrictive blood transfusion on the clinical outcome of ICU patients. METHODS: A total of 271 ICU patients who received RBC transfusion were selected as study subjects. Patients were divided into open transfusion group (pre-transfusion Hb <100g / L) and restricted transfusion group (pre-transfusion Hb <70g / L) according to different transfusion strategies. Two groups of patients were collected, such as age, gender, disease distribution and other general information; Acute physiological and chronic health status score Ⅱ (APACHEⅡscore) and multiple organ dysfunction score (MODS) were recorded in two groups of patients; Hb changes were observed; two groups of patients within 3 weeks of mortality, mortality during hospitalization, and severe infection, pulmonary edema, heart failure incidence. Results: There was no significant difference in average age, APACHEⅡscore, disease distribution between the two groups (P> 0.05). The average transfusion rate of erythrocytes (4.5 ± 3.7) U in each group during hospitalization was lower than that in open transfusion group (6.8 ± 4.6) U, the difference was statistically significant (P <0.05). Hb in the restricted transfusion group and Hb in the ICU were lower than that in the open transfusion group (P <0.05). The mortality rate in the 3-week restricted transfusion group was lower than that in the open hospital (P> 0.05). The incidences of severe infection, pulmonary edema, heart failure and MODS score in restricted blood transfusion group were significantly lower than those in open transfusion group (P> 0.05) <0.05). Conclusion: The ICU patients with restrictive transfusion strategy to reduce unnecessary blood transfusion, saving valuable blood resources and reduce the incidence of transfusion complications.