摘要
Abstract
Objective To evaluate the clinical effect of blood transfusion treatment in elderly critically ill patients under different blood transfusion initiation thresholds.Methods A total of 144 elderly critically ill patients aged>70 years who underwent red blood cell transfusion in the elderly intensive care unit(ICU)of our hospital from January 2021 to January 2023 were included.According to different blood transfusion initiation thresholds,the patients were divided into restrictive blood transfusion group(n=77,Hb<70 g/L before blood transfusion)and liberal blood transfusion group(n=67,Hb 70-100 g/L before blood transfusion).Acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score,estimated mor-tality and general data collection were performed when the two groups of patients entered the ICU.Blood transfusion details of these patients in the ICU were collected and documented,including pre-transfusion Hb levels,volume and number of red blood cell transfusion,and post-transfusion Hb levels.Propensity score matching(PSM)was used to match the baseline data of the two groups of patients,and the clinical outcomes were compared and analyzed after matching.Results After PSM matching,52 pairs of patients were successfully matched.The matched restrictive and liberal transfusion groups showed comparable characterists,including age,APACHE Ⅱ score,the number of cases with APACHE Ⅱ score>20,es-timated mortality,incidence of comorbidities and primary diseases(P>0.05).The number of red blood cell transfusions and transfusion volume(U)in the ICU of the two groups were 7.77±4.73 vs 12.19±10.41,11.64±7.65 vs 19.14±16.14(all P<0.05),and the Hb levels(g/L)before and after red blood cell transfusion in the ICU was 59.92±5.98 vs 77.44±8.60,77.88±17.21 vs 87.56±15.23(all P<0.05).In terms of clinical outcomes,there was no significant difference be-tween the two groups(all P>0.05):ICU length of stay(d)39.56±36.80 vs 40.10±49.29,three-week mortality rate(%)21.2 vs 21.2,in-hospital mortality rate(%)46.2 vs 53.9,mortality rate in subgroup with APACHE Ⅱ score≤20(%)11.5 vs 1.9,the incidence of severe infection(%)78.8 vs 73.1,the incidence of heart failure(%)57.7 vs 44.2,and the incidence of pulmonary edema(%)26.9 vs 19.2.Conclusion Elderly ICU patients can tolerate lower blood transfu-sion thresholds.Therefore,the restrictive transfusion strategy can reduce the total amount of blood transfusion,save valua-ble blood resources,and achieve the same blood transfusion effect as the liberal transfusion strategy.关键词
高龄重症监护/限制性输血/开放性输血/输血策略/临床预后Key words
elderly intensive care/restrictive blood transfusion/liberal blood transfusion/blood transfusion strategy/clinical prognosis分类
医药卫生
