張循善輸血治療傳統(tǒng)觀念的變革與更新xxxx省醫(yī)學會(編輯修改稿)
2025-01-18 18:35 本頁面
【文章內容簡介】 ion ? Decreased CD3, CD4, CD8 Tcells ? Increased soluble cytokine receptor sTNFR, sIL2R ? Increased suppressor Tcell activity ? Reduced natural killer cell activity McAlister FA et al, Br J Surg 1998。85:1718. Innerhofer P et al, Transfusion 1999。39:108996. 24 輸血不能促進傷口愈合 25 手術切口愈合紊亂診斷標準 結果和機制 26 ?underwent laparotomy（剖腹術） ?underwent gastrectomy （胃切除） ?underwent gastroduodenostomy（胃十二指腸吻合術） 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，補多少血”與“失多少血，補多少血”是否合理？？ 31 英國輸血一般原則 32 ? RBCs should be administered as single units for most operative and inpatient indications (transfuse and reassess strategy) except for ongoing blood loss with hemodynamic instability. ? Tx decisions are clinical judgments that should be based on the overall clinical assessment of the individual patient. Transfusion decisions should not be based on laboratory parameters alone. ? Routine premedication is not advised unless the patient has a history of previous transfusion reactions. Premedication has not been shown to reduce the risk of transfusion reactions. Guidelines for Blood Transfusion: PRBCs 33 現(xiàn)代紅細胞輸注適應癥和輸注指征 一 、慢性貧血 ? 貧血時機體的反應 * ? 慢性貧血的輸血目的 提高血紅蛋白水平 ，以保證組織供氧 。 因此應當輸注紅細胞即可 ，不應輸注全血 。 ? 慢性貧血的輸血原則 臨床上輸注紅細胞主要是消除或減輕缺氧癥狀 ， 只要將 Hb水平提高到能保證足夠的組織供氧即可 ， 不需要通過輸血將患者的 Hb水平恢復到正常水平 。 ..\紅細胞保存 \輸血到 HB正常水平不能改變患者的轉歸 .PDF 34 人類耐受低 Hb的能力 35 英國紅細胞輸注指南 （ 2023年） 36 Red Blood Cell Transfusion: A Clinical Practice Guideline From the AABB Ann Intern :4958 直立 37 38 Methods We enrolled 838 critically ill patients who had hemglobin concentrations of less than g /dl and randomly assigned 418 patients to a restrictive strategy of transfusion, in which red cells were transfused if the hemoglobin concentration dropped below g /dl and hemoglobin concentrations were maintained at to g /dl, and 420 patients to a liberal strategy, in which transfusions were given when the hemoglobin concentration fell below g /dl and hemoglobin concentrations were maintained at to g /dl. Results ? Overall, 30
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