摘要
目的探讨大量输血对严重创伤失血患者炎症因子、胰岛B细胞功能及多器官功能不全综合征(MODS)发生率和病死率的影响。方法以河北省邢台市第三医院2015年1月~2019年6月收治的创伤失血且输血的214例病例为研究对象,根据输血量和输血方式分为一般输血组(n=118)和大量输血组(n=96);回顾性调查2组患者输血3 d后血浆TNFα和IL-6等炎症因子、HOMA-B和ΔINS30/ΔGLU30等胰岛B细胞功能指数以及MODS发生率和病死率变化。结果大量输血组与一般输血组输血3 d后血浆TNFα(ng/L)、IL-6(ng/L)、HOMA-B和ΔINS30/ΔGLU3以及MODS发生率分别为64.21±8.41 vs 30.75±5.26、216.52±17.99 vs 152.45±16.26、58.55±10.23 vs 103.47±17.48、2.95±0.69 vs 5.87±1.30以及63.54%(61/96)vs 40.07%(52/118)(P<0.01);MODS病死率分别为46.88%(45/96)vs 33.90%(40/118)(P>0.05)。结论大量输血通过促进炎症反应和导致胰岛B细胞功能不全,可增加严重创伤失血患者MODS发生风险。
Objective To explore the effect of massive blood transfusion on inflammatory factors, islet B cell function, incidence and mortality of multiple organ dysfunction syndrome(MODS) in patients with severe traumatic hemorrhage. Methods 214 traumatic hemorrhage patients who received blood transfusion and were hospitalized in the Third People′s Hospital of Xingtai from January 2015 to June 2019 were enrolled and divided into the routine blood transfusion group(n=118) and massive blood transfusion group(n=96) according to the amount and method of blood transfusion. The changes of the inflammatory factors such as TNF α and IL-6, the functional indexes of Islet B cells such as HOMA-B and Δ INS30/Δ GLU30, and the incidence and mortality of MODS in two groups 3 d after blood transfusion were observed. Results The level of TNF α(ng/L), IL-6(ng/L), HOMA-B and Δ INS30/Δ GLU30 were(64.21±8.41) vs(30.75±5.26),(216.52±17.99) vs(152.45±16.26)(58.55±10.23) vs(103.47±17.48) and(2.95±0.69) vs(5.87±1.30) in the massive transfusion group and routine transfusion group, respectively(P<0.01). The incidence of MODS was 63.54%(61/96) vs 40.07%(52/118)(P<0.01) while the mortality of MODS was 46.88%(40/118) vs 33.90%(P>0.05). Conclusion The massive blood transfusion could increase the incidence of MODS in patients with severe traumatic hemorrhage by promoting inflammatory reaction and dysfunction of islet B cells.
作者
张晶梅
冯存民
张益明
赵金霞
薛云
张秀婷
王帅
王占科
ZHANG Jingmei;FENG Cunmin;ZHANG Yiming;ZHAO Jinxia;XUE Yun;ZHANG Xiuting;WANG Shuai;WANG Zhanke(The Third Hospital of Xingtai,Xingtai 054000,China;The 908 Hospital of the Joint Service Support Force of the Chinese People's Liberation Army;The General Hospital of Jizhong Energy Xingtai Mining Group Co.,Ltd.)
出处
《中国输血杂志》
CAS
2021年第2期107-110,共4页
Chinese Journal of Blood Transfusion
基金
江西省卫生和计划生育委员会课题(20173025)。
关键词
大量输血
创伤失血
多器官功能障碍综合征
炎症因子
胰岛B细胞
功能不全
massive blood transfusion
traumatic hemorrhage
multiple organ dysfunction syndrome(MODS)
inflammatory factors
islet B cell
dysfunction
