Koch Colleen Gorman, Li Liang, Duncan Andra I, Mihaljevic Tomislav, Loop Floyd D, Starr Norman J, Blackstone Eugene H
Department of Cardiothoracic Anesthesia, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Ann Thorac Surg. 2006 May;81(5):1650-7. doi: 10.1016/j.athoracsur.2005.12.037.
Perioperative red blood cell (PRBC) transfusion has been associated with early risk for morbid outcomes, but risk related to long-term survival has not been thoroughly explored. Therefore, we examined the influence of PRBC transfusion and component therapy on long-term survival after isolated coronary artery bypass grafting after controlling for the effect of demographics, comorbidities, operative factors, and the early hazard for death.
The US Social Security Death Index was used to ascertain survival status for 10,289 patients who underwent isolated coronary artery bypass grafting from January 1, 1995 through June 28, 2002. The outcome measure was all-cause mortality during the follow-up period. Unadjusted survival estimates were performed using the Kaplan-Meier techniques. Survival curves for transfusion status were compared with the log-rank test. The parametric decomposition model was used for risk-adjusted survival. A balancing score was calculated for each patient and forced into the final model.
Survival among transfused patients was significantly reduced as compared with nontransfused patients. The instantaneous risk of death displayed a biphasic pattern: a declining hazard phase from the time of the operation (early hazard) up until 6 months postoperatively and then a late hazard that continued out until about 10 years. Transfusion of red cells was associated with a risk-adjusted reduction in survival for both the early (0.34 +/- 0.02, p < 0.0001) and late phases (0.074 +/- 0.016, p < 0.0001).
Perioperative PRBC transfusion is associated with adverse long-term sequela in isolated CABG. Attention should be directed toward blood conservation methods and a more judicious use of PRBC.
围手术期红细胞（PRBC）输血与不良结局的早期风险相关，但与长期生存相关的风险尚未得到充分研究。因此，在控制了人口统计学、合并症、手术因素和早期死亡风险的影响后，我们研究了PRBC输血和成分治疗对单纯冠状动脉旁路移植术后长期生存的影响。
使用美国社会保障死亡指数确定1995年1月1日至2002年6月28日期间接受单纯冠状动脉旁路移植术的10289例患者的生存状况。结局指标为随访期间的全因死亡率。使用Kaplan-Meier技术进行未调整的生存估计。输血状态的生存曲线采用对数秩检验进行比较。参数分解模型用于风险调整后的生存分析。为每位患者计算平衡评分并纳入最终模型。
与未输血患者相比，输血患者的生存率显著降低。死亡的瞬时风险呈现双相模式：从手术时（早期风险）到术后6个月风险下降，然后是持续到约10年的晚期风险。红细胞输血与早期（0.34±0.02，p<0.0001）和晚期（0.074±0.016，p<0.0001）风险调整后的生存降低相关。
围手术期PRBC输血与单纯冠状动脉旁路移植术的不良长期后遗症相关。应关注血液保护方法并更明智地使用PRBC。
