Bein T, Fröhlich D, Frey A, Metz C, Hansen E, Taeger K
Klinik für Anästhesiologie, Universität Regensburg, Germany.
Infusionsther Transfusionsmed. 1995 Apr;22(2):91-6. doi: 10.1159/000223105.
In intensive care medicine the clinical decision to order and transfuse red blood cells (RBC) is usually based on hematocrit or hemoglobin levels. The intention of this study was to investigate whether clinical or laboratory variables, taken after the admission of patients to the intensive care unit (ICU), are able to predict the transfusion requirement of the following 72 h.
The values of initially measured systolic blood pressure, hematocrit level, and the values of 2 scores of severity of disease (Acute Physiology And Chronic Health Evaluation [APACHE-II], Mortality Prediction Model [MPM]) were calculated after the admission of patients to the ICU. The decision for transfusion was based on specific criteria. The median values of the scores, those of the variables, and the median number of transfused RBC units of the surviving group were compared to the values of the group of patients who died during hospital stay. The quantity of RBC transfusions was compared to the variables and score values by linear regression analysis. Additionally, the values of the patients who did not receive blood transfusion were compared to those of patients who required RBC. Furthermore, the patient group with neurosurgical diseases was compared to the group without neurosurgical diseases.
117 patients were prospectively and consecutively investigated in an 8-bed ICU of a university hospital.
Nonsurvivors required significantly more units of RBC during the first 72 h (p < 0.05). Patients who did not require transfusion had a higher hematocrit and a lower APACHE-II value at admission (p < 0.001). In the MPM values no differences were found. Patients with neurosurgical diseases had a higher initial hematocrit value, and they required less units of RBC in comparison to patients without neurosurgical diseases. In the analysis of linear regression neither in the initially measured systolic blood pressure nor in the APACHE-II and MPM we found a strong linear correlation to the quantity of blood transfusion.
A hematocrit value < or = 20% and a APACHE-II score > or = 20 at the time of admission to the ICU referred to a demand for blood transfusion. We believe that these parameters are useful as predictive instruments. The initially measured systolic blood pressure had no prognostic capacity. In the individual patient a number of factors should be taken into account to decide whether to transfuse or not.
在重症监护医学中，决定订购和输注红细胞（RBC）的临床决策通常基于血细胞比容或血红蛋白水平。本研究旨在调查患者入住重症监护病房（ICU）后获取的临床或实验室变量是否能够预测接下来72小时的输血需求。
计算患者入住ICU后最初测量的收缩压、血细胞比容水平以及两个疾病严重程度评分（急性生理与慢性健康评估[APACHE-II]、死亡率预测模型[MPM]）的值。输血决策基于特定标准。将存活组的评分中位数、变量值以及输注RBC单位数的中位数与住院期间死亡患者组的值进行比较。通过线性回归分析将RBC输血量与变量和评分值进行比较。此外，将未接受输血患者的值与需要RBC的患者的值进行比较。此外，将患有神经外科疾病的患者组与无神经外科疾病的患者组进行比较。
在一家大学医院的8张床位的ICU中对117例患者进行了前瞻性连续研究。
非存活者在最初72小时内需要显著更多单位的RBC（p<0.05）。不需要输血的患者入院时血细胞比容较高且APACHE-II值较低（p<0.001）。在MPM值方面未发现差异。与无神经外科疾病的患者相比，患有神经外科疾病的患者初始血细胞比容值较高，且需要的RBC单位数较少。在线性回归分析中，无论是最初测量的收缩压，还是APACHE-II和MPM，我们都未发现与输血量有强线性相关性。
入住ICU时血细胞比容值≤20%且APACHE-II评分≥20表明有输血需求。我们认为这些参数作为预测工具很有用。最初测量的收缩压没有预后能力。对于个体患者，决定是否输血时应考虑多种因素。
