Yang Jiang-Cun, Wang Qiu-Shi, Dang Qian-Li, Sun Yang, Xu Cui-Xiang, Jin Zhan-Kui, Ma Ting, Liu Jing
Department of Transfusion Medicine, Shaanxi Provincial People's Hospital, Xi'an Department of Transfusion Medicine, Shengjing Hospital of China Medical University, Shenyang Department of Dermatology, Shaanxi Provincial People's Hospital, Xi'an Shaanxi Provincial Center for Clinical Laboratory Department of Orthopaedics, Shaanxi Provincial People's Hospital, Xi'an, China Division of Transfusion Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD.
Medicine (Baltimore). 2017 Aug;96(31):e7690. doi: 10.1097/MD.0000000000007690.
The aim of this study was to provide an overview of massive transfusion in Chinese hospitals, identify the important indications for massive transfusion and corrective therapies based on clinical evidence and supporting experimental studies, and propose guidelines for the management of massive transfusion. This multiregion, multicenter retrospective study involved a Massive Blood Transfusion Coordination Group composed of 50 clinical experts specializing in blood transfusion, cardiac surgery, anesthesiology, obstetrics, general surgery, and medical statistics from 20 tertiary general hospitals across 5 regions in China. Data were collected for all patients who received ≥10 U red blood cell transfusion within 24 hours in the participating hospitals from January 1 2009 to December 31 2010, including patient demographics, pre-, peri-, and post-operative clinical characteristics, laboratory test results before, during, and after transfusion, and patient mortality at post-transfusion and discharge. We also designed an in vitro hemodilution model to investigate the changes of blood coagulation indices during massive transfusion and the correction of coagulopathy through supplement blood components under different hemodilutions. The experimental data in combination with the clinical evidence were used to determine the optimal proportion and timing for blood component supplementation during massive transfusion. Based on the findings from the present study, together with an extensive review of domestic and international transfusion-related literature and consensus feedback from the 50 experts, we drafted the guidelines on massive blood transfusion that will help Chinese hospitals to develop standardized protocols for massive blood transfusion.
本研究旨在概述中国医院的大量输血情况，基于临床证据和支持性实验研究确定大量输血的重要指征及纠正治疗方法，并提出大量输血管理指南。这项多地区、多中心的回顾性研究涉及一个大量输血协调小组，该小组由来自中国5个地区20家三级综合医院的50名临床专家组成，这些专家分别专长于输血、心脏外科、麻醉学、妇产科、普通外科和医学统计学。收集了2009年1月1日至2010年12月31日参与研究医院中所有在24小时内接受≥10单位红细胞输注的患者的数据，包括患者人口统计学信息、术前、术中和术后临床特征、输血前、输血期间和输血后的实验室检查结果，以及输血后和出院时的患者死亡率。我们还设计了一个体外血液稀释模型，以研究大量输血期间凝血指标的变化以及在不同血液稀释度下通过补充血液成分纠正凝血障碍的情况。结合实验数据和临床证据来确定大量输血期间补充血液成分的最佳比例和时机。基于本研究的结果，以及对国内外输血相关文献的广泛综述和50位专家的共识反馈，我们起草了大量输血指南，这将有助于中国医院制定标准化的大量输血方案。
