Markham Chris, Small Sara, Hovmand Peter, Doctor Allan
Division of Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, McDonnell Pediatric Research Building, Campus Box 8208, 660 South Euclid Avenue, St Louis, MO 63110-1093, USA.
Social Systems Design Laboratory, Brown School of Social Work, Washington University, Campus Box 1196, 1 Brookings Drive, St Louis, MO 63130, USA.
Pediatr Clin North Am. 2017 Oct;64(5):991-1015. doi: 10.1016/j.pcl.2017.06.003.
Transfusion decision making (TDM) in the critically ill requires consideration of: (1) anemia tolerance, which is linked to active pathology and to physiologic reserve, (2) differences in donor RBC physiology from that of native RBCs, and (3) relative risk from anemia-attributable oxygen delivery failure vs hazards of transfusion, itself. Current approaches to TDM (e.g. hemoglobin thresholds) do not: (1) differentiate between patients with similar anemia, but dissimilar pathology/physiology, and (2) guide transfusion timing and amount to efficacy-based goals (other than resolution of hemoglobin thresholds). Here, we explore approaches to TDM that address the above gaps.
重症患者的输血决策（TDM）需要考虑以下几点：（1）贫血耐受性，这与活动性病变和生理储备有关；（2）供体红细胞生理学与天然红细胞生理学的差异；（3）贫血所致氧输送失败的相对风险与输血本身的风险。目前的TDM方法（如血红蛋白阈值）存在以下问题：（1）无法区分贫血程度相似但病变/生理状况不同的患者；（2）无法将输血时机和输血量导向基于疗效的目标（血红蛋白阈值解决除外）。在此，我们探讨解决上述差距的TDM方法。
