Reeves Barnaby C, Murphy Gavin J
Bristol Heart Institute, University of Bristol, Bristol Royal Infirmary, Bristol, UK.
Curr Opin Cardiol. 2008 Nov;23(6):607-12. doi: 10.1097/HCO.0b013e328310fc95.
Literature since 2006 was reviewed to identify the harms and costs of red blood cell (RBC) transfusion.
Several studies, in people having various cardiac surgery operations, found strong associations of RBC transfusion with mortality and postoperative morbidity. The effect on mortality was strongest close to the time of operation but extended to 5 years. Morbidity outcomes included serious wound and systemic infections, renal failure, prolonged ventilation, low cardiac index, myocardial infarction, and stroke. RBC transfusion was also strongly associated with increased cardiac intensive care unit and ward postoperative stay, and hence, increased cost of admission; available studies did not consider all resources used and the associated costs.
The harms of RBC transfusion have potentially serious and long-term consequences for patients and are costly for health services. This evidence should shift clinicians' equipoise towards more restrictive transfusion practice. The immediate aim should be to avoid transfusing a small number of RBC units for general malaise attributed to anaemia, a practice that appears to occur in about 50% of transfused patients. Randomized trials comparing restrictive and liberal transfusion triggers are urgently needed to directly compare the benefits and harms from RBC transfusion.
回顾2006年以来的文献，以确定红细胞（RBC）输血的危害和成本。
多项针对接受各种心脏手术患者的研究发现，RBC输血与死亡率和术后发病率密切相关。对死亡率的影响在手术前后最为明显，并持续至术后5年。发病结果包括严重伤口和全身感染、肾衰竭、通气时间延长、低心排血量、心肌梗死和中风。RBC输血还与心脏重症监护病房和病房术后住院时间延长密切相关，因此住院费用增加；现有研究未考虑所有使用的资源及其相关成本。
RBC输血的危害对患者可能具有严重的长期后果，对医疗服务而言成本高昂。这一证据应促使临床医生在输血实践中更加倾向于采取限制性策略。当前的目标应是避免因贫血引起的全身不适而输注少量RBC，这种做法似乎在约50%的输血患者中存在。迫切需要进行随机试验，比较限制性和宽松性输血触发阈值，以直接比较RBC输血的利弊。
