Basran Sukhjeewan, Frumento Robert J, Cohen Allison, Lee Samuel, Du Yuling, Nishanian Ervant, Kaplan Harold S, Stafford-Smith Mark, Bennett-Guerrero Elliott
Department of Anesthesiology, College of Physicians & Surgeons of Columbia University, New York, USA.
Anesth Analg. 2006 Jul;103(1):15-20, table of contents. doi: 10.1213/01.ane.0000221167.58135.3d.
Red blood cells (RBCs) undergo numerous changes during storage; however, the clinical relevance of these storage "lesions" is unclear. We hypothesized that the duration of storage of transfused RBCs is associated with mortality after repeat sternotomy for cardiac surgery, because these patients are at high risk for both RBC transfusion and adverse outcome. We retrospectively analyzed 434 patients who underwent repeat median sternotomy for coronary artery bypass graft or valve surgery and who received allogeneic RBCs. Three-hundred-twenty-one (74%) patients met the criteria for eligibility. After adjusting for the effects of confounders and the total number of RBC transfusions, the duration of storage of the oldest RBC unit transfused was found to be associated with both in-hospital mortality (Cox proportional hazard ratio (HR) = 1.151; P < 0.0001) and out-of-hospital mortality (HR = 1.116; P < 0.0001). The mean duration of storage of transfused RBCs was also an independent predictor of in-hospital mortality (HR = 1.036; P < 0.0001). Independent associations between the duration of storage of transfused RBCs and acute renal dysfunction and intensive care unit and hospital length of stay were also observed. The duration of storage of RBCs is associated with adverse outcome after repeat sternotomy for cardiac surgery. The clinical significance of this finding should be investigated in a large, randomized, blinded clinical trial.
红细胞（RBCs）在储存过程中会发生许多变化；然而，这些储存“损伤”的临床相关性尚不清楚。我们推测，心脏手术再次开胸术后输注红细胞的储存时间与死亡率相关，因为这些患者接受红细胞输血和出现不良结局的风险都很高。我们回顾性分析了434例接受冠状动脉搭桥术或瓣膜手术并接受异体红细胞输血的再次正中开胸患者。321例（74%）患者符合入选标准。在调整混杂因素的影响和红细胞输血总数后，发现输注的最陈旧红细胞单位的储存时间与住院死亡率（Cox比例风险比（HR）=1.151；P<0.0001）和院外死亡率（HR=1.116；P<0.0001）均相关。输注红细胞的平均储存时间也是住院死亡率的独立预测因素（HR=1.036；P<0.0001）。还观察到输注红细胞的储存时间与急性肾功能障碍以及重症监护病房和住院时间之间存在独立关联。心脏手术再次开胸术后红细胞的储存时间与不良结局相关。这一发现的临床意义应在一项大型、随机、盲法临床试验中进行研究。
