张循善输血治疗传统观念的变革与更新XXXX省医学会.ppt

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1、输血治疗传统观念的变革与更新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3CritCareMed2009Vol.37,No.12.3124CritCareMed2004;32[Suppl.]:S542–S547意大利国家指南BloodTransfus2009;7:49-64AnnalsofInternalMedicine2012；157（1）：50输血作为支持疗法不再是现代红细

2、胞输注指征4败血症患者要求较高Hb水平的适应证不包括支持目的ConditionsinsepticpatientsthatmayrequireahigherhemoglobinAcuteinstabilityCardiovasculardiseaseCoronaryarterydiseaseLowcardiacoutputPulmonarydiseaseSeverearterialhypoxemiaOrganortissueischemiaSeveremixedvenousdesaturation（混合静脉血氧饱和度，过低表明组织氧合障碍

3、）ElevatedlactatelevelUseofbloodproductsinsepsis:Anevidence-basedreview.CritCareMed2004;32(Suppl):S542–S547.5FFP适应证不包括抗感染输注FFP不能作为支持疗法Fresh-FrozenPlasmaTransfusionQuestion:WhenshouldFFPbetransfusedinpatientswithseveresepsis?Recommendation:RoutineuseofFFPtocorrectlaborator

4、yclottingabnormalitiesintheabsenceofbleedingorplannedinvasiveproceduresisnotrecommended.FFPisindicatedforcoagulopathyduetodocumenteddeficiencyofcoagulationfactors(increasedPTAPTT)inthepresenceofactivebleedingorbeforesurgicalorinvasiveprocedures.Useofbloodproductsinsepsis:

5、Anevidence-basedreview.CritCareMed2004;32(Suppl):S542–S547.6重症患者输注红细胞导致的不良转归From571articlesscreened,45metinclusioncriteriaIn42ofthe45studiestherisksofRBCtransfusionoutweighedthebenefits;Seventeenof18studies,demonstratedthatRBCtransfusionswereanindependentpredictorofdeath;

6、Twenty-twostudiesexaminedtheassociationbetweenRBCtransfusionandnosocomialinfection;inallthesestudiesbloodtransfusionwasanindependentriskfactorforinfection.RBCtransfusionssimilarlyincreasedtheriskofdevelopingmulti-organdysfunctionsyndrome(threestudies)andacuterespiratorydi

7、stresssyndrome(sixstudies).MarikPE,CorwinHL.Efficacyofredbloodcelltransfusioninthecriticallyill:asystematicreviewoftheliterature[J].CritCareMed.2008;36(9):2667-26747相对危险度腹腔间隙综合征8910Prospective,multiplecenter,observationalcohortstudy（观测队列研究）of4,892ICUptsintheUSPropensitysc

8、ore（倾向指数）matchedDesignedtoexaminetherelationshipofanemiaandRBCtransfusionwithclinicaloutcomesAlm