输血治疗传统观念的变革与更新.pptx
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Use of blood products in sepsis: An evidence-based review. Crit Care Med 2004; 32(Suppl):S542–S547.
5
FFP适应证不包括抗感染 输注FFP不能作为支持疗法
Fresh-Frozen Plasma Transfusion Question: When should FFP be transfused in patients with
7
腹腔间隙综合征
相对危险度
8
9
10
Prospective, multiple center, observational cohort study（观测队列研究） of 4,892 ICU pts in the US
Propensity score（倾向指数） matched Designed to examine the relationship of anemia and
severe sepsis? Recommendation: Routine use of FFP to correct laboratory clotting abnormalities in the absence of bleeding or planned invasive procedures is not recommended. FFP is indicated for coagulopathy due to documented deficiency of coagulation factors (increased PT APTT) in the presence of active bleeding or before surgical or invasive procedures.
RBC transfusion with clinical outcomes Almost 95% of patients admitted to the ICU have a
Hb level below “normal” by day 3 In total, 11,391 RBC units were transfused. Overall, 44% of pts admitted to the ICU received one
transfusion and nosocomial infection; in all these studies blood transfusion was an independent risk factor for infection. RBC transfusions similarly increased the risk of developing multiorgan dysfunction syndrome (three studies) and acute respiratory distress syndrome (six studies). Marik PE, Corwin HL. Efficacy of red blood cell transfusion in the critically ill: a systematic review of the literature[J]. Crit Care Med. 2008;36(9):2667-2674
benefits; Seventeen of 18 studies, demonstrated that RBC transfusions were an
independent predictor of death; Twenty-two studies examined the association between RBC
意大利国家指南 Blood Transfus 2009; 7: 49-64
Annals of Internal Medicine 2012 ； 157（1）：50 4
败血症患者要求较高Hb水平的适应证 不包括支持目的
Conditions in septic patients that may require a higher hemoglobin Acute instability Cardiovascular disease
Use of blood products in sepsis: An evidence-based review. Crit Care Med 2004; 32(Suppl):S542–S547.
6
重症患者输注红细胞导致的不良转归
From 571 articles screened, 45 met inclusion criteria In 42 of the 45 studies the risks of RBC transfusion outweighed the
输血治疗传统观念的ຫໍສະໝຸດ Baidu革与更新
安徽医科大学第一附属医院 张循善
1
主要内容
询证输血医学新观念 现代输血疗法的临床应用
2
询证输血医学新观念
输血作为重症患者的支持疗法没有询证 依据
同种输血能够导致外科患者及重症患者 不良转归
输血不能促进伤口愈合 “失多少血，补多少血”是过时、错误
观念
3
输血作为支持疗法不再是现代红细胞输注指征 Crit Care Med 2009 Vol. 37, No. 12. 3124 Crit Care Med 2004; 32[Suppl.]:S542–S547
Coronary artery disease Low cardiac output Pulmonary disease Severe arterial hypoxemia Organ or tissue ischemia Severe mixed venous desaturation（混合静脉血氧饱和度，过 低表明组织氧合障碍） Elevated lactate level
5
FFP适应证不包括抗感染 输注FFP不能作为支持疗法
Fresh-Frozen Plasma Transfusion Question: When should FFP be transfused in patients with
7
腹腔间隙综合征
相对危险度
8
9
10
Prospective, multiple center, observational cohort study（观测队列研究） of 4,892 ICU pts in the US
Propensity score（倾向指数） matched Designed to examine the relationship of anemia and
severe sepsis? Recommendation: Routine use of FFP to correct laboratory clotting abnormalities in the absence of bleeding or planned invasive procedures is not recommended. FFP is indicated for coagulopathy due to documented deficiency of coagulation factors (increased PT APTT) in the presence of active bleeding or before surgical or invasive procedures.
RBC transfusion with clinical outcomes Almost 95% of patients admitted to the ICU have a
Hb level below “normal” by day 3 In total, 11,391 RBC units were transfused. Overall, 44% of pts admitted to the ICU received one
transfusion and nosocomial infection; in all these studies blood transfusion was an independent risk factor for infection. RBC transfusions similarly increased the risk of developing multiorgan dysfunction syndrome (three studies) and acute respiratory distress syndrome (six studies). Marik PE, Corwin HL. Efficacy of red blood cell transfusion in the critically ill: a systematic review of the literature[J]. Crit Care Med. 2008;36(9):2667-2674
benefits; Seventeen of 18 studies, demonstrated that RBC transfusions were an
independent predictor of death; Twenty-two studies examined the association between RBC
意大利国家指南 Blood Transfus 2009; 7: 49-64
Annals of Internal Medicine 2012 ； 157（1）：50 4
败血症患者要求较高Hb水平的适应证 不包括支持目的
Conditions in septic patients that may require a higher hemoglobin Acute instability Cardiovascular disease
Use of blood products in sepsis: An evidence-based review. Crit Care Med 2004; 32(Suppl):S542–S547.
6
重症患者输注红细胞导致的不良转归
From 571 articles screened, 45 met inclusion criteria In 42 of the 45 studies the risks of RBC transfusion outweighed the
输血治疗传统观念的ຫໍສະໝຸດ Baidu革与更新
安徽医科大学第一附属医院 张循善
1
主要内容
询证输血医学新观念 现代输血疗法的临床应用
2
询证输血医学新观念
输血作为重症患者的支持疗法没有询证 依据
同种输血能够导致外科患者及重症患者 不良转归
输血不能促进伤口愈合 “失多少血，补多少血”是过时、错误
观念
3
输血作为支持疗法不再是现代红细胞输注指征 Crit Care Med 2009 Vol. 37, No. 12. 3124 Crit Care Med 2004; 32[Suppl.]:S542–S547
Coronary artery disease Low cardiac output Pulmonary disease Severe arterial hypoxemia Organ or tissue ischemia Severe mixed venous desaturation（混合静脉血氧饱和度，过 低表明组织氧合障碍） Elevated lactate level