Waggoner J R, Wass C T, Polis T Z, Faust R J, Schroeder D R, Offord K P, Piepgras D G, Joyner M J
Department of Anesthesiology, Mayo Clinic, Rochester, Minn 55905, USA.
Mayo Clin Proc. 2001 Apr;76(4):376-83.
To evaluate changes in the institution's red blood cell (RBC) transfusion practice during the past 15 years and the influence of these changes on neurologic or cardiac morbidity after carotid endarterectomy.
Based on a retrospective analysis of the Mayo Clinic database, 1,114 patients who underwent carotid endarterectomy were stratified into 1 of 2 groups: (1) 1980 to 1985 (ie, pre-human immunodeficiency virus screening, early-practice group [n=552]) and (2) 1990 to 1995 (ie, recent-practice group [n=562]). Data were compared between time periods using the chi2 test for categorical variables and the rank sum test for continuous variables. Logistic regression was used to assess the association between perioperative transfusion practice and the occurrence of stroke or myocardial infarction. Two-tailed P values < or = 05 were considered statistically significant.
Patients in the recent-practice group were significantly older (mean +/- SD age, 69.6 +/- 8.7 years) vs 65.9 +/- 8.3 years in the early-practice group (P<.001). The proportion of patients receiving perioperative RBC transfusion decreased dramatically from 72.9% in 1980-1985 to 8.7% in 1990-1995 (P<.001). Additionally, the mean +/- SD number of RBC units transfused decreased from 1.10 +/- 1.30 U in 1980-1985 to 0.27 +/- 1.22 U in 1990-1995 (P<.001). Mean +/- SD discharge hemoglobin concentration decreased from 13.7 +/- 1.4 g/dL in 1980-1985 to 11.8 +/- 1.5 g/dL in 1990-1995 (P<.001). Rates of perioperative stroke and myocardial infarction did not differ between the 2 time periods (early-practice group vs recent-practice group: stroke, 5.1% vs 3.6% [P=.22]; myocardial infarction, 1.5% vs 2.3% [P=.29]).
Our results suggest that elderly patients undergoing carotid endarterectomy (ie, individuals known to be at high risk for cerebral and cardiac ischemia) can tolerate modest perioperative anemia despite a considerable change in the institution's transfusion practice (lower "transfusion trigger," the hemoglobin concentration or hematocrit value below which RBC transfusion is indicated).
评估该机构在过去15年中红细胞（RBC）输血实践的变化，以及这些变化对颈动脉内膜切除术后神经或心脏发病率的影响。
基于梅奥诊所数据库的回顾性分析，1114例行颈动脉内膜切除术的患者被分为以下两组之一：（1）1980年至1985年（即，人类免疫缺陷病毒筛查前，早期实践组[n = 552]）和（2）1990年至1995年（即，近期实践组[n = 562]）。使用卡方检验对分类变量和秩和检验对连续变量在不同时间段之间进行数据比较。采用逻辑回归评估围手术期输血实践与中风或心肌梗死发生之间的关联。双侧P值≤0.05被认为具有统计学意义。
近期实践组患者明显比早期实践组患者年龄大（平均±标准差年龄，69.6±8.7岁vs 65.9±8.3岁，P<0.001）。接受围手术期RBC输血的患者比例从1980 - 1985年的72.9%急剧下降至1990 - 1995年的8.7%（P<0.001）。此外，RBC输注单位的平均±标准差数量从1980 - 1985年的1.10±1.30 U降至1990 - 1995年的0.27±1.22 U（P<0.001）。平均±标准差出院时血红蛋白浓度从1980 - 1985年的13.7±1.4 g/dL降至1990 - 1995年的11.8±1.5 g/dL（P<0.001）。两个时间段之间围手术期中风和心肌梗死的发生率没有差异（早期实践组vs近期实践组：中风，5.1% vs 3.6% [P = 0.22]；心肌梗死，1.5% vs 2.3% [P = 0.29]）。
我们的结果表明，接受颈动脉内膜切除术的老年患者（即已知有脑和心脏缺血高风险的个体）尽管该机构的输血实践有相当大的变化（较低的“输血阈值”，即低于该值表明需输注RBC的血红蛋白浓度或血细胞比容值），仍能耐受适度的围手术期贫血。
