急性上消化道出血患者不同输血策略的输血疗效评估
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摘要
目的:探讨急性上消化道出血患者中限制性输血和开放性输血2种不同输血策略输血后疗效评估。方法:对185例急性上消化道出血患者临床资料进行回顾性分析,按照不同输血方案分成2组,其中以Hb<70 g/L标准行限制性输血治疗的为观察组(96例),按照Hb<90 g/L标准进行开放性输血治疗的为对照组(89例)。结果:观察组输血后24 h内Hb及Hct指标较输血前明显升高,差异有统计学意义(P<0.05),对照组输血后24 h内Hb及Hct指标较输血前水平比较,差异无统计学意义(P>0.05),凝血指标PT、APTT及再次输血率和不良反应率在输血前后对比中,观察组与对照组差异有统计学意义(P<0.05)。结论:限制性输血与开放性输血相比在急性上消化道出血患者输血策略中具有明显优势,可显著改善患者贫血状况,降低患者凝血功能紊乱发生率及再次输血率,减少不良反应的发生,保障患者输血安全。
Objective:To evaluate the efficacy of two different transfusion strategies,restrictive transfusion and open transfusion,in the patients with acute upper gastrointestinal hemorrhage. Method:The clinical data of 185 patients with acute upper gastrointestinal hemorrhage in our hospital were retrospectively analyzed.They were divided into two groups according to different blood transfusion schemes.The observation group received restrictive blood transfusion according to the standard of Hb<70 g/L(n=96) and the control group received open blood transfusion according to the standard of Hb<90 g/L(n=89).Analysis of blood routine,coagulation parameters,retransfusion rate and incidence of adverse reactions before and after transfusion. Result:The indexes of Hb and Hct in the observation group were significantly higher than those before transfusion within 24 hours after transfusion.It had statistical differences(P<0.05).The indexes of Hb and Hct in the control group within 24 hours after transfusion had no statistical difference compared with those before transfusion(P>0.05).The indexes of PT,APTT,re-transfusion rate and adverse reactions were significantly different between the observation group and the control group before and after transfusion.The difference was statistically significant(P<0.05).Conclusion:Compared with open transfusion,restrictive transfusion had obvious advantages in transfusion strategy for patients with acute upper gastrointestinal hemorrhage.It could significantly improve the anemia status of patients,reduce the incidence of coagulation dysfunction and re-transfusion rate,reduce the occurrence of adverse reactions and ensure the safety of blood transfusion.
Objective:To evaluate the efficacy of two different transfusion strategies,restrictive transfusion and open transfusion,in the patients with acute upper gastrointestinal hemorrhage. Method:The clinical data of 185 patients with acute upper gastrointestinal hemorrhage in our hospital were retrospectively analyzed.They were divided into two groups according to different blood transfusion schemes.The observation group received restrictive blood transfusion according to the standard of Hb<70 g/L(n=96) and the control group received open blood transfusion according to the standard of Hb<90 g/L(n=89).Analysis of blood routine,coagulation parameters,retransfusion rate and incidence of adverse reactions before and after transfusion. Result:The indexes of Hb and Hct in the observation group were significantly higher than those before transfusion within 24 hours after transfusion.It had statistical differences(P<0.05).The indexes of Hb and Hct in the control group within 24 hours after transfusion had no statistical difference compared with those before transfusion(P>0.05).The indexes of PT,APTT,re-transfusion rate and adverse reactions were significantly different between the observation group and the control group before and after transfusion.The difference was statistically significant(P<0.05).Conclusion:Compared with open transfusion,restrictive transfusion had obvious advantages in transfusion strategy for patients with acute upper gastrointestinal hemorrhage.It could significantly improve the anemia status of patients,reduce the incidence of coagulation dysfunction and re-transfusion rate,reduce the occurrence of adverse reactions and ensure the safety of blood transfusion.
引文
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[7] 陈妤,田虹,黄晓丽,等.肝硬化合并非静脉曲张性上消化道出血临床分析[J].中山大学学报(医学科学版),2014,35(2):278-283.
[8] 王敬波,胡旭梅,王伟,等.严重失血患者成分血与全血大量输注的对比[J].临床血液学杂志,2015,28(8):672-674.
[9] 德翠,文思思,胡海春,等.输血不良反应发生情况调查分析[J].临床血液学杂志,2018,31(8):613-617.
[10] 韩洪祯.术中限制性输血与开放性输血的临床对比[J].东南国防医药,2016,18(1):54-55,72.
[2] 黄萍.浅析上消化道出血患者的诊断及治疗进展[J].世界最新医学信息文摘,2015,15(51):22-23.
[3] 李素萍,郭宝华,马升高,等.限制输血在急性消化道出血治疗中的应用观察[J].当代医学,2016,22(2):38-39.
[4] 黄小燕,唐周舟,吴秋芳.严重创伤患者大量输血时动态监测凝血指标的临床意义[J].现代医学,2017,45(1):79-82.
[5] 辛峰,高海燕,孔燕,马现君.血液成分的输血比例对大量输血患者死亡率影响[J].临床血液学杂志,2017,30(10):815-819.
[6] 何雨芩,陈东风.消化道出血限制性输血策略的新认识[J].胃肠病学,2017,22(7):432-434.
[7] 陈妤,田虹,黄晓丽,等.肝硬化合并非静脉曲张性上消化道出血临床分析[J].中山大学学报(医学科学版),2014,35(2):278-283.
[8] 王敬波,胡旭梅,王伟,等.严重失血患者成分血与全血大量输注的对比[J].临床血液学杂志,2015,28(8):672-674.
[9] 德翠,文思思,胡海春,等.输血不良反应发生情况调查分析[J].临床血液学杂志,2018,31(8):613-617.
[10] 韩洪祯.术中限制性输血与开放性输血的临床对比[J].东南国防医药,2016,18(1):54-55,72.