协和医学杂志

2016, v.7(05) 367-370

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单次住院红细胞用量超过20U的外科手术患者用血情况
Blood Use in Surgical Patients with Red Blood Cell Transfusion of Over 20 Units during Single Hospital Stay

赵奕;林进;李汉忠;方沅湘;王爽;
ZHAO Yi;LIN Jin;LI Han-zhong;FANG Yuan-xiang;WANG Shuang;Department of Urology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;Department of Orthopedics,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;Department of Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;Department of Plastic Surgery,Plastic Surgery Hospital,Chi

摘要(Abstract):

目的总结北京协和医院单次住院红细胞用量超过20 U外科手术患者的用血情况,以探讨合理用血策略。方法 2015年1月至10月北京协和医院外科手术患者单次住院红细胞用量超过20 U的患者27例,收集其临床资料,对围术期及术中成分输血情况和患者结局进行分析。结果 27例患者中,男性22例,女性5例。27例患者围术期共输注血液制品红细胞867 U,血浆124 800 ml,血小板50治疗量。围术期红细胞用量20~29 U 15例(55.6%),最高用量92 U。术中累计输注红细胞334 U,占围术期总输注量的38.5%;术中输注血浆32 000 ml,占围术期总输注量的25.6%。平均住院时间43 d,其中住院时间<7 d者1例(2.3%),>60 d者3例(11.1%)。治疗后顺利出院患者16例(59.3%),放弃治疗患者5例(18.5%),死亡患者6例(22.2%)。结论术前评估及术前多科全面会诊对于输血决策及病情评估至关重要。术中遇到大量出血时应尽快采取止血措施,根据出血量科学把握输血时机。同时应加强用血管理,避免血液资源的浪费。
Objective To assess the blood use in surgical patients with red blood cell( RBC) transfusion of over 20 U during single hospital stay in Peking Union Medical College Hospital( PUMCH) in order to help develop strategy for rational blood use. Methods We collected 27 surgical patients which received RBC transfusion of over 20 U during single hospital stay between January and October 2015 in PUMCH,and analyzed the data of these patients in aspects of baseline characteristics,blood use in perioperative period and during surgery,and treatment outcome. Results There were 22 males and 5 females in the 27 patients. A total of 867 U RBCs,124 800 ml blood plasma,and 50 U platelets were transfused in them. Fifteen patients( 55. 6%) received 20 ~29 U RBCs in perioperative period,and the maximum volume of RBCs use per person was 92 U. Three hundred and thirty-four U RBCs were transfused during surgery,accounted for 38. 5% of the total use; 32 000 ml blood plasma was transfused during surgery,accounted for 25. 6% of the total volume used in perioperative period. Themean length of hospital stay was 43 days,with 1 patient hospitalized for less than 7 days( 2. 3%) and 3 for more than 60 days( 11. 1%). Sixteen patients( 59. 3%) were discharged after successful treatment,5 patients( 18. 5%) gave up treatment,and 6 patients died( 22. 2%). Conclusions It is very important to perform preoperative assessment and cross-department consultation for rational blood transfusion strategy and disease severity evaluation. In order to reduce the volume of blood transfusion,conducting prompt hemostasis in the cases of major bleeding during surgery and seizing the appropriate timing for blood transfusion is essential. Management of blood use should also be strengthened for better use of blood product.

关键词(KeyWords): 大量输血;外科;手术
massive transfusion;department of surgery;operation

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作者(Author): 赵奕;林进;李汉忠;方沅湘;王爽;
ZHAO Yi;LIN Jin;LI Han-zhong;FANG Yuan-xiang;WANG Shuang;Department of Urology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;Department of Orthopedics,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;Department of Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;Department of Plastic Surgery,Plastic Surgery Hospital,Chi

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