限制性红细胞输血在ICU:临床坚持的趋势
Merijn C Reuland1, Senta J Raasveld2, Alexander P J Vlaar1
1Amsterdam UMC, Department of Intensive Care Medicine, Meibergdreef 9, Amsterdam, 1105 AZ, NH, The Netherlands.
概括
在ICU中实施限制性红细胞 (RBC) 输血协议,成功降低了血红蛋白触发. 这种坚持指导方针的做法改善了重症患者的输血实践.
科学领域:
- 关键护理医学 关键护理医学
- 输血医学 输血医学
- 血液学 血液学 血液学
背景情况:
- 在重症患者中输血红细胞 (RBC) 的最佳血红蛋白值仍在争论中.
- 目前的指导方针建议采用限制性输血策略,血红蛋白触发值为7g/dL.
- 然而,与该协议的偏差是常见的,输血通常在更高的血红蛋白水平下进行.
研究的目的:
- 评估在重症监护室 (ICU) 内遵守严格的红细胞输血协议.
- 评估随着时间的推移,红细胞输血实践和政策的变化.
- 根据参考专业,分析不同患者子组的坚持.
主要方法:
- 进行了一项回顾性观察性队列研究.
- 数据包括2017年至2024年在阿姆斯特丹UMC的24,761次ICU住院.
- 从电子健康记录和荷兰国家质量登记处 (NICE) 提取了信息.
主要成果:
- 红细胞输血前的血红蛋白水平中位数显著下降,从2017年的7.7g/dL降至2024年的6.8g/dL (p < 0.001).
- 血红细胞输血的百分比在血红蛋白低于7g/dL的情况下从18.8%增加到64.8% (p < 0.001).
- 这些趋势在所有患者子组中都是一致的.
结论:
- 在第三级护理重症监护室成功实施了全面限制性红细胞输血协议的长期实施.
- 该方案的有效性独立于患者的转诊专业.
- 到2024年,输血前血红蛋白水平的中位数达到6.8g/dL,这表明成功遵守了限制性输血实践.
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