Walsh Timothy S, McArdle Fiona, McLellan Stuart A, Maciver Caroline, Maginnis Michael, Prescott Robin J, McClelland D Brian
Department of Anaesthesia, New Edinburgh Royal Infirmary, Edinburgh, Scotland, UK.
Crit Care Med. 2004 Feb;32(2):364-71. doi: 10.1097/01.CCM.0000108878.23703.E0.
To determine whether transfusion of red cells either < or =5 days or > or =20 days from donation alters tonometric indexes of gastric mucosal oxygenation or global oxygenation parameters in euvolemic anemic critically ill patients without ongoing hemorrhage. The a priori hypothesis was that stored red cells worsen gastric oxygenation.
Prospective, double-blind, randomized study.
A 12-bed general medical/surgical intensive care unit in a Scottish teaching hospital.
Ventilated euvolemic anemic (mean +/- sd hemoglobin, 85.8 +/- 8.4 g/L) critically ill patients with significant organ failure, but no evidence of hemorrhage.
After baseline measurements, patients were randomized to receive two units of leukodepleted red cells that were either < or =5 days (ten patients) or > or =20 days (12 patients) after donation according to a standardized protocol.
Changes in gastric to arterial Pco2 gap (Pg-Paco2 gap), gastric intramucosal pH, arterial pH, arterial base excess, and arterial lactate concentrations were measured during baseline (2.5 hrs), during transfusion (3 hrs), and for 5 hrs after transfusion. Mean age of red cells stored < or =5 days was 2 days (first and third quartile, 2, 2.25; range, 2-3); red cells stored >/=20 days had a mean age of 28 days (first and third quartile, 27, 31; range, 22-32). Hemoglobin concentration increased by 15.0 g/L and 16.6 g/L, respectively, in the fresh and stored groups (p =.62). There were no significant differences between the groups either using treatment-by-time analysis or comparing the pre- and posttransfusion periods either for Pg-Paco2 gap (mean difference, 0.03 kPa; 95% confidence limits, -1.66, 1.72) or gastric intramucosal pH (mean difference, 0.015 pH units; 95% confidence limits, -0.054, 0.084). The mean change within each group from the pre- to posttransfusion period for Pg-Paco2 gap and gastric intramucosal pH, respectively, was 0.56 kPa (95% confidence limits, -0.68, 1.79) and -0.018 pH units (95% confidence limits, -0.069, 0.032) for "fresh" red cells and 0.52 kPa (95% confidence limits, -0.6, 1.64) and -0.033 pH units (95% confidence limits, -0.080, 0.129) for "stored" red cells. There was no statistically or clinically significant improvement in any other oxygenation index during the measurement period for either group compared to baseline values.
Transfusion of stored leukodepleted red cells to euvolemic, anemic, critically ill patients has no clinically significant adverse effects on gastric tonometry or global indexes of tissue oxygenation. These findings do not support the use of fresh red cells in critically ill patients.
确定给无持续出血的血容量正常的贫血重症患者输注保存时间≤5天或≥20天的红细胞，是否会改变胃黏膜氧合的张力测定指标或整体氧合参数。预先假设是保存的红细胞会使胃氧合恶化。
前瞻性、双盲、随机研究。
苏格兰一家教学医院的一个拥有12张床位的普通内科/外科重症监护病房。
机械通气的血容量正常的贫血（平均±标准差血红蛋白，85.8±8.4 g/L）重症患者，伴有严重器官功能衰竭，但无出血迹象。
在进行基线测量后，根据标准化方案，将患者随机分为两组，分别接受两单位去除白细胞的红细胞，一组输注的红细胞保存时间≤5天（10例患者），另一组输注的红细胞保存时间≥20天（12例患者）。
在基线期（2.5小时）、输血期间（3小时）以及输血后5小时，测量胃与动脉血二氧化碳分压差值（Pg - Paco2差值）、胃黏膜内pH值、动脉血pH值、动脉血碱剩余以及动脉血乳酸浓度的变化。保存时间≤5天的红细胞平均保存天数为2天（第一和第三四分位数分别为2天、2.25天；范围为2 - 3天）；保存时间≥20天的红细胞平均保存天数为28天（第一和第三四分位数分别为27天、31天；范围为22 - 32天）。新鲜组和保存组的血红蛋白浓度分别升高了15.0 g/L和16.6 g/L（p = 0.62）。无论是采用治疗时间分析，还是比较输血前后的时间段，两组在Pg - Paco2差值（平均差值为0.03 kPa；95%置信区间为 - 1.66, 1.72）或胃黏膜内pH值（平均差值为0.015 pH单位；95%置信区间为 - 0.054, 0.084）方面均无显著差异。每组从输血前到输血后时间段内，“新鲜”红细胞组的Pg - Paco2差值和胃黏膜内pH值的平均变化分别为0.56 kPa（95%置信区间为 - 0.68, 1.79）和 - 0.018 pH单位（95%置信区间为 - 0.069, 0.032），“保存”红细胞组分别为0.52 kPa（95%置信区间为 - 0.6, 1.64）和 - 0.033 pH单位（95%置信区间为 - 0.080, 0.129）。与基线值相比，在测量期间两组的任何其他氧合指标均无统计学或临床意义上的显著改善。
给血容量正常的贫血重症患者输注保存的去除白细胞的红细胞，对胃张力测定或组织氧合的整体指标无临床显著不良影响。这些发现不支持在重症患者中使用新鲜红细胞。
