NEJM:输血时红细胞越新鲜越好吗?

2015-04-13 Mechront 译 MedSci原创

先前有观察性研究表明,输注贮存超过2-3周的红细胞,会使严重的致命的不良反应事件发生风险增加。对于外科手术病人,因为其输血的可能性更大,特别容易受到输血不良反应的影响。

先前有观察性研究表明,输注贮存超过2-3周的红细胞,会使严重的致命的不良反应事件发生风险增加。对于外科手术病人,因为其输血的可能性更大,特别容易受到输血不良反应的影响。



为了验证该观察性研究的结论,Steiner ME 等人于2010-2014年间,在多地点进行了一项随机试验。研究纳入了年龄≥12岁、进行复杂的心脏手术、输注红细胞的病人,按照术中和术后输注少白细胞红细胞贮存时间长短,将其随机分组,一组贮存时间≤10天(贮存时间短)。另一组贮存时间≥21天(贮存时间长)。研究以术前和术后七天内多器官功能障碍得分改变(MODS,0-24分,分越高暗示更多的器官有更严重的损害)和死亡率作为研究初始指标。

研究共纳入1098名病人,短贮存时间组其输注的红细胞平均贮存时间为7天,长贮存时间组的平均为28天,两组MODS得分改变分别增高8.5分和8.7分,两组数据差值的95% CI, −0.6 to 0.3; P = 0.44。术后7天内短贮存时间组和长贮存组死亡率分别为2.8%、2.0%(P = 0.43),28天死亡率分别为4.4%、5.3% (P = 0.57)。除了高胆红素血症在长贮存时间组更常见以外,其他不良反应事件发生率在两组中差别无统计学意义。

研究结果表明,红细胞的贮存期长短不会影响术前术后MODS得分改变。同时研究者们也没有发现,对于年龄≥12岁的行复杂心脏手术的病人,输注贮存时间≤10天的红细胞,其效果会优于贮存时间≥21天的红细胞。

原始出处:

Steiner ME,et al: Effects of Red-Cell Storage Duration on Patients Undergoing Cardiac Surgery.N Engl J Med. 2015 Apr 9;372(15):1419-29. doi: 10.1056/NEJMoa1414219.


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    2015-04-21 yydlt

    老外实验做的很好!

    0

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    2015-04-21 yydlt

    以后千万注意啊

    0

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    2015-04-15 windight
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    2015-04-15 吴颖

    受教了

    0

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    2015-04-14 Handyuan

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