Posluszny Joseph A, Conrad Peggie, Halerz Marcia, Shankar Ravi, Gamelli Richard L
Department of Surgery, Burn and Shock Trauma Institute, Loyola University Medical Center, Maywood, IL, USA.
J Trauma. 2011 Jul;71(1):26-31. doi: 10.1097/TA.0b013e3181f2d9ed.
Critically ill patients require transfusions because of acute blood loss and the anemia of critical illness. In critically ill burn patients, typically, no distinction is made between transfusions related to acute surgical blood loss and those related to the anemia of critical illness. We sought to identify the percentage of blood transfusions due to the anemia of critical illness and the clinical characteristics associated with these transfusions in severely burned patients.
Sixty adult patients with ≥20% total body surface area (TBSA) burn who were transfused at least 1 unit of packed red blood cells during their hospitalization were studied. Clinical variables including age, %TBSA burn, Acute Physiology and Chronic Health Evaluation (APACHE) II score, number of ventilator days, inhalation injury, and number of operative events were correlated with the total number of packed red blood cell units and percentage of nonsurgical transfusions in these patients. Nonsurgical transfusions were defined as transfusions occurring after postoperative day 1 for each distinct operative event and were classified as being caused by the anemia of critical illness.
Patients were transfused an average of 16.6 units ± 21.2 units. Nonsurgical transfusions accounted for 52% of these transfusions. APACHE II score, %TBSA burn, number of ventilator days, and number of operative events, all correlated with total transfusions. However, nonsurgical transfusions correlated with only APACHE II score (p = 0.01) and number of ventilator days (p = 0.03). There was no correlation between nonsurgical transfusions and other clinical variables.
The anemia of critical illness is responsible for >50% of all transfusions in severely burned patients. The initial severity of critical illness (APACHE II score) and duration of the critical illness (number of ventilator days) correlated with transfusions related to anemia of critical illness. Further investigation into the specific risk factors for these transfusions may help to develop strategies to further reduce transfusion rates.
重症患者因急性失血和危重病贫血而需要输血。在重症烧伤患者中，通常并未区分与急性手术失血相关的输血和与危重病贫血相关的输血。我们试图确定重症烧伤患者中因危重病贫血导致的输血比例以及与这些输血相关的临床特征。
研究了60例成年患者，这些患者全身烧伤总面积（TBSA）≥20%，住院期间至少输注了1单位浓缩红细胞。将包括年龄、TBSA烧伤百分比、急性生理与慢性健康状况评分系统（APACHE）Ⅱ评分、机械通气天数、吸入性损伤及手术次数等临床变量与这些患者的浓缩红细胞单位总数及非手术输血百分比进行关联分析。非手术输血定义为每个不同手术事件术后第1天之后发生的输血，并归类为由危重病贫血引起。
患者平均输注16.6单位±21.2单位。非手术输血占这些输血的52%。APACHEⅡ评分、TBSA烧伤百分比、机械通气天数及手术次数均与总输血量相关。然而，非手术输血仅与APACHEⅡ评分（p = 0.01）和机械通气天数（p = 0.03）相关。非手术输血与其他临床变量之间无相关性。
危重病贫血导致了重症烧伤患者超过50%的输血。危重病的初始严重程度（APACHEⅡ评分）和危重病持续时间（机械通气天数）与危重病贫血相关的输血有关。对这些输血的特定危险因素进行进一步研究可能有助于制定策略以进一步降低输血率。
