[重症监护病房诊断性实验室检查导致的失血。初步研究]

[Blood loss from diagnostic laboratory tests performed in intensive care units. Preliminary study].

作者信息

Alazia M, Colavolpe J C, Botti G, Corda N, Ramero C, François G

机构信息

Département d'anesthésie-réanimation, hôpital de la Timone Adultes, Marseille, France.

出版信息

Ann Fr Anesth Reanim. 1996;15(7):1004-7. doi: 10.1016/s0750-7658(96)89468-8.

DOI:10.1016/s0750-7658(96)89468-8

PMID:9180974

Abstract

OBJECTIVE

To assess the volume of blood samples withdrawn for laboratory testing in intensive care unit (ICU) patients and to determine the influence of the resulting blood loss on transfusion requirements in patients staying in the ICU for more than seven days.

STUDY DESIGN

Prospective clinical open study.

PATIENTS

Fifty patients treated in the ICU over the 3-month study period, neither admitted for a systematic postoperative monitoring, nor experiencing bleeding or haemolysis.

METHODS

For each patient the following data were obtained: duration of ICU stay, volume of the daily withdrawn blood, the concentration of haemoglobin (Hb) at the time of ICU admission, ICU discharge and before each transfusion, volume of transfused blood.

RESULTS

A mean volume of 62 +/- 29 mL.d-1 of blood was taken. It decreased from 85 +/- 6 mL on admission day, to 66 +/- 6 mL after seven days and 60 +/- 8 mL after 14 days. About 27% of the withdrawn blood was rejected (initial blood reflowing through cannula and connection tube). Twenty-one patients (42%) had a length of stay greater than 7 days. In this population, a first group (13/21) was given transfusions of packed red cells during their hospitalisation and a second group (8/21) was not transfused. The mean volume of blood taken per day (67 +/- 21 mL.d-1 vs 55 = 15 mL.d-1) and the total volume (1.204 +/- 810 mL vs 810 +/- 389 mL) were not significantly higher in the transfused group. Conversely, the mean haemoglobin concentration on ICU admission (97 +/- 22 g.L-1 vs 136 +/- 26 g.L-1) was significantly lower (P = 0.001) in the transfused patients.

CONCLUSION

Blood losses from blood withdrawal for laboratory tests are important and in agreement with the results of other reports. It is generally accepted that iatrogenic blood loss of this magnitude can cause anaemia if repeated over a prolonged period. Conversely, our data suggest that blood sampling does not contribute significantly to anaemia and transfusion requirements in patients with a prolonged ICU stay.

摘要

目的

评估重症监护病房（ICU）患者为进行实验室检测而抽取的血样量，并确定由此导致的失血对入住ICU超过7天的患者输血需求的影响。

研究设计

前瞻性临床开放研究。

患者

在为期3个月的研究期间，50例在ICU接受治疗的患者，既非因系统性术后监测入院，也未发生出血或溶血。

方法

获取每位患者的以下数据：ICU住院时间、每日抽取的血量、ICU入院时、出院时及每次输血前的血红蛋白（Hb）浓度、输血量。

结果

平均每日采血62±29 mL·d⁻¹。入院当日为85±6 mL，7日后降至66±6 mL，14日后为60±8 mL。约27%的采血量被弃用（初始血液通过套管和连接管回流）。21例患者（42%）住院时间超过7天。在该人群中，第一组（13/21）住院期间接受了浓缩红细胞输注，第二组（8/21）未输血。输血组每日平均采血量（67±21 mL·d⁻¹对55 = 15 mL·d⁻¹）和总采血量（1204±810 mL对810±389 mL）无显著更高。相反，输血患者ICU入院时的平均血红蛋白浓度（97±22 g·L⁻¹对136±26 g·L⁻¹）显著更低（P = 0.001）。