張循善輸血治療傳統(tǒng)觀念的變革與更新xxxx省醫(yī)學(xué)會-全文預(yù)覽
【正文】 ? From 571 articles screened, 45 met inclusion criteria ? In 42 of the 45 studies the risks of RBC transfusion outweighed the benefits。 輸血治療傳統(tǒng)觀念的變革與更新 安徽醫(yī)科大學(xué)第一附屬醫(yī)院 張循善 1 主要內(nèi)容 ? 詢證輸血醫(yī)學(xué)新觀念 ? 現(xiàn)代輸血療法的臨床應(yīng)用 2 詢證輸血醫(yī)學(xué)新觀念 ?輸血作為重癥患者的支持療法沒有詢證依據(jù) ?同種輸血能夠?qū)е峦饪苹颊呒爸匕Y患者不良轉(zhuǎn)歸 ?輸血不能促進(jìn)傷口愈合 ?“失多少血，補(bǔ)多少血”是過時、錯誤觀念 3 Crit Care Med 2023 Vol. 37, No. 12. 3124 Crit Care Med 2023。 32(Suppl):S542–S547. 5 FFP適應(yīng)證不包括抗感染 輸注 FFP不能作為支持療法 FreshFrozen Plasma Transfusion Question: When should FFP be transfused in patients with severe sepsis? Remendation: ? Routine use of FFP to correct laboratory clotting abnormalities in the absence of bleeding or planned invasive procedures is not remended. ? 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. Use of blood products in sepsis: An evidencebased review. Crit Care Med 2023。 in all these studies blood transfusion was an independent risk factor for infection. ? RBC transfusions similarly increased the risk of developing multian 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. 2023。32(1):3952 12 ? Analysis of 24,112 enrollees in 3 large international trials of patients with acute coronary syndromes ? Association between transfusion and oute ? Cox proportional hazards modeling ? Main oute = 30 day mortality Rao SV et al. JAMA. 2023。 95% CI to 。39:108996. 24 輸血不能促進(jìn)傷口愈合 25 手術(shù)切口愈合紊亂診斷標(biāo)準(zhǔn) 結(jié)果和機(jī)制 26 ?underwent laparotomy（剖腹術(shù)） ?underwent gastrectomy （胃切除） ?underwent gastroduodenostomy（胃十二指腸吻合術(shù)） CONCLUSIONS: Blood transfusions increased the incidence of anastomotic abscess（膿腫） and impaired anastomotic wound healing. 27 2023 and June 2023 we have performed a prospective observational study in 1553 elective and emergency patients who underwent median sternotomy for heart surgery. CONCLUSIONS: According to our results, the total amount of allogeneic blood transfused is a major factor contributing to sternal dehiscence （胸骨裂開） regardless of other risk preconditions. European Journal of Anaesthesiology: May 2023 Volume 23 Issue p 12 28 Colorectal :3627 29 30 “缺多少血，補(bǔ)多少血”與“失多少血，補(bǔ)多少血”是否合理？？ 31 英國輸血一般原則 32 ? R
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