Watkins Thomas C, Clark Christopher T
University of Tennessee Medical Center, Graduate School of Medicine, Department of Pathology, Knoxville, Tennessee 37920, USA.
J Infus Nurs. 2013 Mar-Apr;36(2):116-21. doi: 10.1097/NAN.0b013e318282a6cd.
Sepsis is a major cause of patient morbidity and mortality. Many critically ill patients are septic, and red blood cell transfusion is often part of their treatment plan. Studies have shown that red blood cell transfusion is associated with a dose-dependent increase in patient morbidity and mortality. Although red blood cells are transfused to increase the recipient's oxygen-carrying capacity, there are new and emerging data to support that red blood cell transfusion may potentially decrease perfusion and oxygen delivery to the microcirculation, particularly when older red blood cells are transfused. In addition, there are similar effects in the pathophysiology of sepsis that may overlap with the changes that occur with storage of red blood cells. This article will discuss recent literature addressing red cell transfusion in critically ill and septic patients and discuss general guidelines for red cell transfusion in this patient population. This article will also discuss the epidemiology and pathophysiology of sepsis and relate how storage and transfusion of red cells may potentially contribute to changes observed in a septic patient.
脓毒症是患者发病和死亡的主要原因。许多重症患者患有脓毒症，红细胞输血往往是其治疗方案的一部分。研究表明，红细胞输血与患者发病和死亡的剂量依赖性增加有关。尽管输注红细胞是为了增加受血者的携氧能力，但有新出现的数据支持红细胞输血可能会潜在地减少对微循环的灌注和氧输送，尤其是在输注老化红细胞时。此外，脓毒症的病理生理学中存在类似的效应，可能与红细胞储存时发生的变化重叠。本文将讨论近期关于重症和脓毒症患者红细胞输血的文献，并讨论该患者群体红细胞输血的一般指南。本文还将讨论脓毒症的流行病学和病理生理学，并阐述红细胞的储存和输血如何可能导致脓毒症患者出现观察到的变化。
