Spinelli Elena, Bartlett Robert H
University of Michigan ECLS Laboratory, Ann Arbor, MI, USA.
University of Michigan ECLS Laboratory, Ann Arbor, MI, USA
J Intensive Care Med. 2016 Jun;31(5):295-306. doi: 10.1177/0885066615571901. Epub 2015 Feb 18.
The objective of this report is to review the physiology and management of anemia in critical care. Selected publications on physiology and transfusion related to anemia and critical care, including the modern randomized trials of conservative versus liberal transfusion policy, were used. Anemia is compensated and tolerated in most critically ill patients as long as oxygen delivery is at least twice oxygen consumption. There are risks to blood transfusion which can be minimized by blood banking practice. The availability of cultured red cells may allow correction of anemia without significant risk. The benefit of transfusion in anemia must be weighted against the risk in any specific patient.
In a criticially ill patient, anemia should be managed to avoid oxygen supply dependency (oxygen delivery less than twice comsumption) and to maintain moderate oxygen delivery reserve (DO2/VO2 > 3).
本报告旨在综述危重症患者贫血的生理学及管理。选用了与贫血及危重症相关的生理学和输血方面的出版物，包括保守与宽松输血策略的现代随机试验。只要氧输送至少是氧消耗的两倍，大多数危重症患者的贫血就能得到代偿和耐受。输血存在风险，可通过血库操作将其降至最低。培养红细胞的可得性或许能在无显著风险的情况下纠正贫血。在任何特定患者中，输血治疗贫血的益处必须与风险相权衡。
对于危重症患者，应管理贫血以避免氧供依赖（氧输送低于消耗的两倍）并维持适度的氧输送储备（DO2/VO2 > 3）。
