摘要
目的探讨血液成分输注对脓毒血症患者预后的影响因素,为临床上脓毒血症患者提供更加合理、科学的输血方案治疗方案。方法通过回顾性分析收集中南大学湘雅二医院2022年1月至2023年12月的232名脓毒血症患者临床资料,将其按照输血与否分为输血组(n=64)与未输血组(n=168);将输血组患者按照生存结局再分成死亡组(n=26)与未死亡组(n=38),比较2组之间患者的基本资料以及临床实验室指标;使用logistic回归分析血液成分输注对脓毒血症患者预后的影响因素。结果输血组与未输血组相比,患者凝血指标(凝血酶原时间、活化部分凝血活酶时间、国际标准化比值、D-二聚体)、炎症指标(C反应蛋白、降钙素原、白介素-6)等显著增高,而血红蛋白、血小板计数、淋巴细胞计数、纤维蛋白原、白蛋白、血糖、血氧饱和度等指标较未输血组相比显著降低(P<0.05);输血组与未输血组C反应蛋白(mg/L)、血红蛋白(g/L)和血小板计数(×10^(9)/L)分别为178.0(156.1~178)vs 102.7(74.0~119.6)、88.5(72.3~113.0)vs 110.5(101~121.8)、63.0(26.5~156.5)vs 202.5(108.3~286.8)(P均<0.05);logistic回归分析发现患者血红蛋白、血小板计数、乳酸含量及输注红细胞储存时间均是影响脓毒血症输血患者生存结局的危险因素(P<0.05);脓毒血症输血患者死亡组与未死亡组的乳酸含量(mmol/L)和红细胞储存时间(d)分别为3.5(1.9~7.7)vs 2.1(1.3~3.5)、18.0(13.0~18.0)vs 12.0(9.0~14.0)(P均<0.05)。结论脓毒血症患者输血组与未输血组相比,存在着基础情况较差、感染程度较重的情况,且生存结局较差;更重要的是,研究发现血液成分输注的决策时机和血液成分质量管控(如储存时间)可能直接影响患者预后,这为临床优化脓毒血症患者的输血策略提供了关键依据。
Objective To identify influencing factors associated with the prognosis of sepsis patients receiving blood component transfusion,and to provide a more rational and scientific transfusion strategy for clinical management.Methods Clinical data of 232 patients with sepsis treated at the Second Xiangya Hospital of Central South University between January 2022 and December 2023 were retrospectively analyzed.These patients were categorized into the transfusion group(n=64)and the non-transfusion group(n=168)based on whether they received transfusions,and the patients in the transfusion group were further divided into non-survivor group(n=26)and survivor group(n=38)based on their survival outcome.Baseline characteristics and clinical characteristics were compared between two groups.Factors impacting the prognosis of sepsis patients undergoing blood component transfusion were identified using logistic regression.Results Compared to the non-transfusion group,the transfusion group showed significantly higher levels of coagulation indicators(prothrombin time,activated partial thromboplastin time,international normalized ratio,D-dimer)and inflammatory markers(C-reactive protein,procalcitonin,interleukin-6),while the level of hemoglobin,platelet,lymphocyte,fibrinogen,albumin,blood glucose,and oxygen saturation were significantly lower(P<0.05).The[M(P25,P75)]for C-reactive protein(mg/L),hemoglobin(g/L),and platelet count(×10^(9)/L)in the transfusion vs non-transfusion groups were 178.0(156.1-178)vs 102.7(74.0-119.6),88.5(72.3-113.0)vs 110.5(101-121.8),and 63.0(26.5-156.5)vs 202.5(108.3-286.8),respectively(all P<0.05).Logistic regression analysis revealed that hemoglobin level,platelet count,lactate concentration,and the storage duration of transfused red blood cells were independent risk factors affecting the survival outcomes of sepsis patients receiving transfusions(P<0.05).In septic transfusion patients,the[M(P25,P75)]lactate concentration(mmol/L)and RBC storage time(d)in the non-survivor vs survivor groups were 3.5(1.9-7.7)vs 2.1(1.3-3.5),18.0(13.0-18.0)vs 12.0(9.0-14.0),respectively(both P<0.05).Conclusion Compared to non-transfused sepsis patients,those receiving transfusions exhibited poorer baseline conditions,more severe infections,and worse survival outcomes.More importantly,the study found that the timing of transfusion decisions and the quality control of blood products(such as storage duration)may directly impact patient prognosis,providing critical evidence for optimizing transfusion strategies in septicemia patients.
作者
赵冰洁
操博为
朱远裴
张宁洁
ZHAO Bingjie;CAO Bowei;ZHU Yuanpei;ZHANG Ningjie(Department of Blood Transfusion,Second Xiangya Hospital,Central South University,Changsha 410000,China;Department of Histology and Embryology,Basic School of Medicine Sciences,Central South University,Changsha 410000,China)
出处
《中国输血杂志》
2025年第7期879-885,共7页
Chinese Journal of Blood Transfusion
基金
国家自然科学基金项目(82102281)
湖南省自然科学基金青年项目(2021JJ40893)。
关键词
脓毒血症
血液成分输注
预后影响
sepsis
blood component transfusion
prognosis influence
