摘要
目的:研究危重病人在红细胞输注后血浆总血红素浓度的变化及其与预后关系。方法:这项前瞻性队列研究于2017年10月~2018年6月期间在本院ICU中进行。选择222名需要红细胞输血的连续重症监护患者作为研究对象。测量输血前储存的红细胞单位中的总血红素和输血前后患者血浆中的总游离血红素。结果:在222名连续输血的ICU患者中,有88例患者在住院期间死亡。与幸存组相比,非幸存组患者的ApacheⅡ评分显著增加,而住院时间显著缩短。RBC输注后血浆总血红素浓度显著升高(输注前36[27~77]μmol/L vs.输注后48[36~74]μmol/L)。输血后,非幸存组患者血浆总血红素浓度明显高于幸存组(54[35~133]μmol/Lvs.44[31~66]μmol/L)。采用多变量logistic回归分析对血清胆红素、年龄和ApacheⅡ评分进行校正后,输血后血浆总血红素与住院死亡率之间的关系仍然显著(OR=1.79,95%CI=1.17-2.96)。结论:危重病人RBC输血后血浆血红素总量增加,输血后浓度与住院死亡率独立相关。
Objective To study the changes of plasma total heme concentration in critically ill patients after erythrocyte transfusion and its relationship with prognosis.Methods The prospective cohort study was conducted in the ICU of our hospital from October 2017 to June 2018.222 consecutive intensive care patients requiring red blood cell transfusion were selected as the study subjects.Plasma heme was measured in red blood cell units before transfusion and in the patients’plasma before and after transfusion.Results Of 222 consecutive ICU patients,88 died during hospitalization.Compared with the surviving group,the ApacheⅡscore of the non-surviving group was significantly increased,while the length of hospitalization was significantly shortened.Total plasma heme levels increased in response to transfusion,from 36(27-77)μmol/L to 48(36-74)μmol/L.After transfusion,the plasma total heme concentration in the non-surviving group was significantly higher than that in the surviving group(54[35-133]μmol/L vs.44[31-66]μmol/L).The relationship between posttransfusion total plasma heme and mortality remained significant after adjustment for serum bilirubin,age and APACHE II score using multivariable logistic regression analysis(OR=1.79,95%CI,=1.17-2.96).Conclusion Total plasma heme increases after red blood cell transfusion in critically ill patients,and the posttransfusion concentration is independently associated with hospital mortality.
作者
仲晓玲
张静
刘亚东
Zhong Xiao-ling;Zhang Jing;Liu Ya-dong(Department of Blood Transfusion,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medicine School,Nanjing 210008,China)
出处
《晓庄学院学报（医学版）》
2020年第6期71-74,共4页
Journal of Hunan Normal University(Medical Sciences)
关键词
危重病人
红细胞
血红素
住院死亡率
输血
critical patients
red blood cells
heme
in-hospital mortality
blood transfusion
