The rate of secondary injuries in stroke patients at acute phase

Background: Secondary injuries are frequent in stroke patients at the acute phase. The early rehabilitation for these patients currently still hasn't received enough attention. Thus it may increase the rate of the secondary disorders. Objectives: To describe the common secondary injuries in stroke patients at the acute phase. Subjects: 90 stroke patients over 18 years old that had experienced hemiplegia less than 30 days, and were treated at Neurology Department, Bach Mai Hospital. Method: Cross-sectional study. Data was analyzed by SPSS software, version 13.0. Results: The rate of the secondary injuries in these patients had reached 80.0%. Among them, the rate of pneumonia is the highest with 30.0%, then urological infections with 17.8%, followed by muscular atrophies, contracture of muscles, stress ulcer, and orthostatic hypotension. There is a close relation between pneumonia and perception impairment: the rate of pneumonia in perception impairment patients was 5.25 folds higher than that in patients without perception impairment (67.9% vs. 12.9%, p< 0.001). Similarly, pneumonia rate in patients with nasogastric tube was 4.2 folds higher than that of patients without nasogastric tube (90.9% vs. 21.5%, p< 0.001). Conclusion: The rate of the secondary injuries in acute stroke patients is high. It is necessary to carry out intensive nursing and rehabilitation for these patients.

The study on free hemoglobin concentrations in surgical patients with massive blood transfusion

Background: Hemoglobin is a composition of erythrocyte. They are released from the lysis of erythrocyte. Objectives: to study free hemoglobin concentrations in surgical patients received massive blood transfusion (MBT). Subject and methods: 48 adult patients (male: 31 (64.6%), female: 17 (35.4%), mean age: 36 \xb1 16) with more than 3000ml of storage blood were tested for plasma free hemoglobin. The major reason for MBT were severe trauma (45.8%), the remainder were non - trauma. The change of Hb free was followed in 16 patients at the times of 1500 ml, 2000 ml, 3000 ml storage blood transfused (9 \xb1 3 days). Results: Plasma free hemoglobin was detected after 2,000ml of red cell transfusion and during the first 24h post MBT in 100% cases. Plasma free hemoglobin concentration trended to increase with quantity of transfused blood (0.56 \xb1 0.3 g/dl after 2000 ml, 0.76 \xb1 0.47 g/dl after 3000 ml, and 0.93 \xb1 0.41 g/dl after 5000 ml). There was no correlation between free hemoglobin concentration in plasma of patients with the storage time of blood transfused, and no difference of plasma free hemoglobin concentration between in trauma and non trauma patients. Conclusion: The blood with short time of storage is recommended after 1500ml blood transfusion in these patients. \r\n', u'\r\n', u'

Research on blood biochemical indexes in surgical patients with massive blood transfusion at Viet Duc hospital

Background: Massive blood transfusion is common in surgery: trauma, complicated surgery, organ implantation. Stored blood contains much lactate, ammonia, products of metabolism. These products have negative effects on patient\u2019s metabolic function which may be a cause of death. Objective: To study the change of blood biochemical indexes in surgical patients with massive blood transfusion at Viet Duc hospital. Subjects and method: A prospective study was conducted in the adult patients who had emergency and operation at Viet Duc hospital, from December/2004 to August/2006. All of them were transfused over 3000 ml of blood within 24 hours (pre-operation, intra-operation and post-operation). Results: During the period of study, there were 70 surgical patients with massive blood transfusion: men were more than woman (64%) and the mean age: 38\xb117. The survival rate was significantly improved (57%). The average transfused blood per patient per 24 hours was 3995ml\xb11067ml. There was a decrease in the value of pH, acid-base and HCO3 (the average pH value 7.218\xb10.181, lowest value 6.7). The average value of pH and HCO3\xac was higher in the survival patients than died patients (p<0.05). The mean level of K+ was 3.8\xb10.96mml/l. The increase in the level of K+ had a positive association with the amount of transfused blood. The mean level of Ca++ \xac\xacdecreased under the normal level (0.98mml). Conclusion: It should monitor blood gas and electrolytes continuously in surgical patients with massive blood transfusion in order to identify disorders soon for timely treatment.

Mortality and the factors related to the death in surgical patients with massive blood transfusion

Background: Massive Blood Transfusion is common in surgery, which can save many lives. However, massive blood transfusion in a short time together with other disorders can cause serious side effects and death. Objective: Investigation on the factors related to mortality in surgical patients after massive blood transfusion. Subject and Method: A descriptive study was carried out on 90 patients of massive blood transfusion in Viet Duc hospital. Results: There were 38 cases of death among the 90 patients of massive blood transfusion (42%), in which 97.7% died within 2 to 24 days of hospitalization (caused by multi organ failure). There are no correlation between the deaths, with the units of blood transfused, hypothermia, anemia (Hb) and with platelet counts, APTT, PT, fibrinogen changes, 3 risk factors that correlated significantly with mortality are BE, DIC and age of patients. Conclusion: Acidosis (pH, BE) and hemostasis status should be closely monitored and corrected early to reduce the risks of mortality.

Blood and blood components using in the treatment of surgical patients in Viet Duc Hospital from 1998 to 2000

Authors reviewed all patients who received blood ad blood components during hospitalization and found that: The total number of patients received blood is 7073. The total blood (WB, RBC, plasma) use is 24041 units, approximate 5838L with medium number: 1944L per years, 612L per month, 3 units per 1 patient, especially in emergency operation: >30%. The blood components transfusion application is limited: RBC: 3524 units (14%), FFP: 3248 units (13%), mean while whole blood use rate is high: > 71%. Hematology and blood transfusion department in Viet Duc Hospital has been producing successfully blood components (Red Blood Cells, Fresh Frozen Plasma, Platelets concentrate, Cryoprecipitated...) for clinical use.