Chan Yi-Ling, Han Shih-Tsung, Li Chih-Huang, Wu Chin-Chieh, Chen Kuan-Fu
Department of Emergency Medicine, Chang Gung Memorial Hospital Linkou, Taoyuan 330, Taiwan.
Department of Emergency Medicine, Chang Gung Memorial Hospital Keelung, Keelung 204, Taiwan.
Int J Mol Sci. 2017 Sep 11;18(9):1946. doi: 10.3390/ijms18091946.
Sepsis is one of the major causes of death worldwide, and is the host response to infection which renders our organs malfunctioning. Insufficient tissue perfusion and oxygen delivery have been implicated in the pathogenesis of sepsis-related organ dysfunction, making transfusion of packed red blood cells (pRBCs) a reasonable treatment modality. However, clinical trials have generated controversial results. Even the notion that transfused pRBCs increase the oxygen-carrying capacity of blood has been challenged. Meanwhile, during sepsis, the ability of our tissues to utilize oxygen may also be reduced, and the increased blood concentrations of lactate may be the results of strong inflammation and excessive catecholamine release, rather than impaired cell respiration. Leukodepleted pRBCs more consistently demonstrated improvement in microcirculation, and the increase in blood viscosity brought about by pRBC transfusion helps maintain functional capillary density. A restrictive strategy of pRBC transfusion is recommended in treating septic patients.
脓毒症是全球主要的死亡原因之一，是机体对感染的反应，可导致我们的器官功能失调。组织灌注不足和氧输送不足与脓毒症相关器官功能障碍的发病机制有关，这使得输注浓缩红细胞（pRBCs）成为一种合理的治疗方式。然而，临床试验产生了有争议的结果。甚至输注pRBCs会增加血液携氧能力这一观点也受到了挑战。同时，在脓毒症期间，我们组织利用氧气的能力也可能降低，血液中乳酸浓度升高可能是强烈炎症和儿茶酚胺过度释放的结果，而非细胞呼吸受损。去除白细胞的pRBCs更一致地显示出微循环的改善，pRBC输血导致的血液粘度增加有助于维持功能性毛细血管密度。建议采用限制性pRBC输血策略治疗脓毒症患者。
