Lawrence Valerie A, Silverstein Jeffrey H, Cornell John E, Pederson Thomas, Noveck Helaine, Carson Jeffrey L
Veterans Evidence-Based Research Dissemination and Implementation Center(VERDICT), South Texas Veterans Health Care System, San Antonio, Texas, USA.
Transfusion. 2003 Dec;43(12):1717-22. doi: 10.1046/j.0041-1132.2003.00581.x.
The benefits and indications for blood transfusion are controversial. One possible reason to transfuse is to improve functional recovery after major surgery. However, the data linking improved function with higher Hb concentration are limited.
A: retrospective cohort study was performed in 5793 patients at least 60 years old undergoing hip fracture repair at 20 academic and community hospitals. The primary outcome was distance walked at the time of discharge from the hospital. The mean postoperative Hb concentration was the main exposure variable and was defined as the average value from Day 1 after surgery to discharge. We used robust regression to assess the association between postoperative Hb level with distance walked, controlling for other preoperative variables that could influence functional recovery.
On bivariate analysis, the predicted distance walked at discharge in feet (95% CI) increased with higher Hb levels (7 g/dL, 56 feet [42-70]; 8 g/dL, 61 feet [54-68]; 9 g/dL, 67 feet [64-70]; 10 g/dL, 74 feet [72-77]; 11 g/dL, 83 feet [80-85]; 12 g/dL, 92 feet [87-96]). After adjustment for other factors associated with ability to walk, higher average postoperative Hb level was independently associated with walking greater distance (p < 0.001).
Higher postoperative Hb level may improve functional recovery after hip fracture repair. If confirmed with clinical trials, this finding would provide a rationale to maintain higher Hb concentrations in elderly patients recovering from surgery.
输血的益处和适应症存在争议。输血的一个可能原因是改善大手术后的功能恢复。然而，将功能改善与较高血红蛋白浓度联系起来的数据有限。
对20家学术和社区医院中5793例至少60岁接受髋部骨折修复手术的患者进行了一项回顾性队列研究。主要结局是出院时行走的距离。术后平均血红蛋白浓度是主要暴露变量，定义为术后第1天至出院的平均值。我们使用稳健回归来评估术后血红蛋白水平与行走距离之间的关联，并控制其他可能影响功能恢复的术前变量。
在双变量分析中，出院时预测的行走距离（95%置信区间）随着血红蛋白水平的升高而增加（7g/dL，56英尺[42-70]；8g/dL，61英尺[54-68]；9g/dL，67英尺[64-70]；10g/dL，74英尺[72-77]；11g/dL，83英尺[80-85]；12g/dL，92英尺[87-96]）。在对与行走能力相关的其他因素进行调整后，术后较高的平均血红蛋白水平与行走更远的距离独立相关（p<0.001）。
术后较高的血红蛋白水平可能改善髋部骨折修复后的功能恢复。如果临床试验得到证实，这一发现将为在从手术中恢复的老年患者中维持较高的血红蛋白浓度提供理论依据。
