严重脑外伤患者输血策略的选择

IF 0.1 Q4 MEDICINE, GENERAL & INTERNAL
D. V. Oleniuk, O. V. Tsarov
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引用次数: 0

摘要

创伤性脑损伤(TBI)仍是导致长期残疾的主要原因之一,尤其是在中青年人群中。治疗创伤性脑损伤患者的主要方向之一是防止因全身功能障碍导致的继发性脑损伤的发生。其中,贫血占有重要地位。贫血被认为是危重病人病情严重程度的标志,并被列入重症监护室的风险预测参数清单。然而,贫血与创伤性脑损伤患者不良预后之间的关系还存在争议。这项工作的目的是分析贫血对严重创伤性脑损伤病程的影响,确定贫血在脑损伤病理生理机制中的位置、输血相关并发症的发生,评估不同输血策略(自由输血和限制性输血)及其对治疗结果的影响,同时考虑到个体对贫血的耐受性。然而,将最佳血红蛋白水平作为开始输血的触发因素缺乏明确的证据,因此更需要进一步的临床研究。使用多模态神经监测仪可以对评估个体血红蛋白阈值的最新方法进行评估。这些方法有助于识别并发症风险增加的患者,并确定管理贫血的最佳策略。严重创伤性脑损伤患者对贫血的耐受性问题仍是一个有争议的话题,确定这类患者输血的血红蛋白阈值需要进一步研究,因此应特别注意采用个体化方法解决红细胞输注问题,尤其要综合考虑患者的临床状态和并发病症。应始终权衡因脑氧饱和度恶化导致贫血而可能造成脑损伤恶化的风险与发生输血相关并发症的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The choice of blood transfusion strategy in severe traumatic brain injury
Traumatic brain injury (TBI) remains one of the leading causes of long-term disability, especially among young and middle-aged people. One of the main directions of treatment for patients with TBI is to prevent the development of secondary brain damage due to systemic dysfunction. Anemia occupies an important place among them. Anemia is considered a marker of illness severity in critically ill patients and is included in the list of parameters for risk prediction in intensive care units. However, the relationship between anemia and adverse outcomes in patients with TBI is controversial. Aim. The purpose of the work is to analyze the effect of anemia on the course of severe TBI, to determine the position of anemia in the pathophysiological mechanisms of brain damage, the development of blood transfusion-associated complications, to evaluate different blood transfusion strategies (liberal and restrictive) and their impact on treatment results, taking into account individual tolerance to anemia. Studies suggest that the restrictive transfusion strategy could be useful in reducing complications and length of hospital stay. However, the lack of clear evidence for optimal hemoglobin levels as a trigger to initiate blood transfusions reinforces the need for further clinical studies. The use of multimodal neuromonitoring allows to evaluate the latest approaches to assessing individual hemoglobin thresholds. These methods could help in identifying patients at increased risk of complications and determining optimal strategies to manage anemia. Conclusions. The problem of tolerance to anemia in patients with severe TBI remains a controversial topic, and determining hemoglobin thresholds for blood transfusion in this group of patients requires further studies, special attention should therefore be paid to an individual approach to resolving the issue of red blood cell transfusion, in particular, integrating clinical status of a patient and concomitant pathology. The risk of possible brain damage worsening associated with anemia due to deterioration of cerebral oxygenation should always be weighed against the risk of developing transfusion-associated complications.
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来源期刊
Zaporozhye Medical Journal
Zaporozhye Medical Journal MEDICINE, GENERAL & INTERNAL-
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发文量
72
审稿时长
8 weeks
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