Study on the value of combined application of universal red blood cell transfusion and matching blood transfusion in the rescue of traumatic hemorrhagic shock
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摘要: 目的:探索创伤失血性休克患者抢救治疗中通用型红细胞输血联合配合型输血的应用价值。方法:选取2016年9月-2019年9月我院收治的90例创伤失血性休克患者作为研究对象,随机分为对照组、通用型+交叉配血输血组、通用型+配合型输血组,每组30例。对照组实施传统紧急输血,通用型+交叉配血输血组在15 min内进行通用型红细胞输血、随后进行ABO/RhD血型及交叉配血相合输血,通用型+配合型输血组在15 min以内发通用型红细胞输血、随后予ABO或RhD主要抗原相合的配合型输血。比较3组的病死率、输血有效性、输血不良反应和红细胞不规则抗体检测阳性率。结果:通用型+配合型输血组与通用型+交叉配血输血组24 h内病死率和总病死率均低于对照组,差异均有统计学意义(P<0.05);通用型+配合型输血组24 h内病死率和总病死率与通用型+交叉配血输血组比较,差异无统计学意义(P>0.05);3组间的24 h后病死率比较差异无统计学意义(P>0.05)。输血后24 h, 3组红细胞计数、血红蛋白浓度、红细胞比容均高于输血前,差异均有统计学意义(P<0.05),但3组间比较差异均无统计学意义(P>0.05)。3组患者输血后24 h内过敏、非溶血性发热、溶血等不良反应发生率比较差异无统计学意义(P>0.05)。输血后1个月,3组患者红细胞不规则抗体检出率差异无统计学意义(P>0.05)。结论:创伤失血性休克患者输注通用型红细胞后继续予以配合型输血,该方案有效性与安全性与传统紧急输血方案相当,但可降低24 h病死率和总病死率,值得推广。Abstract: Objective:To explore the applied value of universal red blood cell transfusion combined with matching blood transfusion in the rescue and treatment of patients with traumatic hemorrhagic shock.Methods:Ninety patients with traumatic hemorrhagic shock admitted to our hospital from September 2016 to September 2019 were selected as research objects, and were randomly divided into control group, universal + cross matching blood transfusion group and universal + matched blood transfusion group, including 30 cases in each group. The control group received traditional emergency blood transfusion. In the universal + cross matching blood transfusion group, the universal red blood cell transfusion was carried out within 15 minutes, followed by both ABO/RhD blood grouping and cross matching transfusion. In the universal + matched blood transfusion group, the universal red blood cell transfusion was carried out within 15 minutes, followed by major antigen as ABO or RHD compatible matched blood transfusion. Then, the mortality, transfusion efficiency, transfusion side effects and positive detection rate of RBC irregular antibody were compared among the three groups.Results:The 24-hour mortality and total mortality of universal + cross matching blood transfusion group and universal + matched blood transfusion group were both significantly lower than those of the control group(P<0.05), while there were no significant differences in 24-hour mortality and total mortality between the universal + matched blood transfusion group and the universal + cross matching blood transfusion group(P>0.05), and there were no significant differences in mortality after 24 hours among the three groups(P>0.05). 24 hours after blood transfusion, the red blood cell count, hemoglobin concentration and hematocrit of the three groups were higher than those before blood transfusion and the differences were statistically significant(P<0.05), but there were no statistical differences among the three groups(P>0.05). There were no significant differences in the incidence of allergy, non hemolytic fever and hemolysis within 24 hours after blood transfusion among the three groups(P>0.05). One month after transfusion, there were no significant differences among the three groups in the detection rate of RBC irregular antibody(P>0.05).Conclusion:The method for patients with traumatic hemorrhagic shock who receive matching blood transfusion after universal red blood cell transfusion, is as effective and safe as the traditional emergency blood transfusion scheme, but can reduce 24-hour mortality and total mortality, so it is worth popularizing.
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