摘要
探讨建设血液重症监护病房(HCU)对于提升血液专科重症救治能力的重要性。本文介绍我国HCU的两种运行模式(ICU模式与pre-ICU模式)及实践经验,主张在血液病区内建设、完善呼吸循环监护与血液净化等设备,由接受重症培训的血液科医师主导,或通过标准化流程与综合ICU高效协作;对尚未达标的单位建议设抢救室并加强重症培训。HCU主要收治对象为血液病相关严重或致命性出血、重症感染与脓毒性休克、初诊急性髓系白血病/急性早幼粒细胞白血病(AML/APL)早期并发症、治疗相关并发症、进展迅速高致死性疾病及需器官支持或血液净化患者。强调病情量化评估与早期转入:应用国家早期预警评分(NEWS)、quick-序贯器官衰竭评分(SOFA)、SOFA/ΔSOFA、多国癌症支持治疗协会(MASCC)等工具分层,尽早实施脓毒症集束化治疗,优先经鼻高流量湿化氧疗(HFNC)改善氧合;在肾功能衰竭伴少尿或无尿、充血性心力衰竭、药物过量等指征下行连续性肾脏替代治疗(CRRT);原发病治疗遵循“三级分层”和“观察-调整”策略,兼顾患者意愿。倡议具备条件的血液中心积极筹建HCU,探索诊疗新模式,提高血液专科重症救治能力。
Establishing hematology care units(HCU)is essential for strengthening hematologyspecific critical care capacity.This article outlines two HCU operational models in China—the ICU model and the pre-ICU model—and discusses practical insights from their implementation.It recommends establishing HCU within hematology wards,equipped for respiratory and hemodynamic monitoring and blood purification,and led by hematologists trained in critical care or by teams collaborating efficiently with general ICU through standardized workflows.For units not yet meeting these standards,establishing a resuscitation room and strengthening critical care training are advised.HCU primarily admit patients with severe or life-threatening bleeding due to hematologic diseases,severe infections or septic shock,early complications of newly diagnosed acute myeloid leukemia or acute promyelocytic leukemia(AML/APL),treatment-related complications,rapidly progressive or highly lethal conditions,and those requiring organ support or blood purification.Emphasis is placed on quantitative assessment of disease severity and timely transfer to the HCU,using tools such as the National Early Warning Score,quick Sequential Organ Failure Assessment(qSOFA),SOFA/ΔSOFA,and the Multinational Association of Supportive Care in Cancer risk index for patient stratification.Early implementation of sepsis bundles is emphasized.For organ support,high-flow nasal cannula oxygen therapy is prioritized to improve oxygenation.Continuous renal replacement therapy is performed when there are indications such as renal failure with oliguria or anuria,congestive heart failure,or drug overdose,etc.Treatment of the underlying hematologic disease follows a“three-tier stratification”and“watch-and-adjust”strategy,while respecting patient preferences.We encourage eligible hematology centers to actively establish HCU,explore new care models,and strengthen hematology-specific critical care capacity.
作者
范圣瑾
李海涛
张曦
Fan Shengjin;Li Haitao;Zhang Xi(Hematology Intensive Care Unit,the First Affiliated Hospital of Harbin Medical University,Harbin 150001,China;Medical Center of Hematology,the Second Affiliated Hospital of Army Medical University(Xinqiao Hospital),Institute of Science Innovation for Blood Ecology and Intelligent Cells,PLA Center for Hematologic Diseases,PLA Key Clinical Specialty,Chongqing Municipal Key Clinical Specialty,State Key Laboratory of Trauma and Chemical Poisoning,Chongqing 400037,China)
出处
《中华血液学杂志》
北大核心
2025年第11期985-990,共6页
Chinese Journal of Hematology
