Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania 19107, USA.
Neurosurgery. 2010 Feb;66(2):312-8; discussion 318. doi: 10.1227/01.NEU.0000363747.47587.6C.
Red blood cell transfusion (RBCT) is associated with medical complications in general medical and surgical patients. We examined the hypothesis that RBCT during intensive care unit (ICU) care is associated with medical complications after subarachnoid hemorrhage (SAH).
We retrospectively analyzed a prospective observational database containing 421 patients with SAH (mean age, 51.5 years; standard deviation, 14.6 years). Logistic regression models were used to adjust for age, admission hemoglobin (Hgb), clinical grade, average ICU Hgb, and symptomatic vasospasm.
Two hundred fourteen patients received an RBCT during their ICU stay. Medical complications were identified in 156 patients and were more common in those who received blood (46%) than in those who did not (29.8%) (P < .001). Major medical complications (cardiac, pulmonary, renal, or hepatic) occurred in 111 patients, and minor complications (eg, skin rash, deep vein thrombosis) occurred in 45 patients. Any non-central nervous system infection (n = 183; P < .001), including pneumonia (n = 103; P < .001) or septicemia (n = 36; P = .02), was more common with RBCT. Central nervous system infections (meningitis, cranial wound, n = 15) also were associated with RBCT (P = .03). Mechanically ventilated patients (n = 259) were more likely to have received an RBCT than those who did not (P < .001). When logistic regression was used to control for age, admission clinical grade and Hgb, average ICU Hgb, symptomatic vasospasm, and other admission variables associated with outcome, the following factors (odds ratio; 95% confidence interval) were associated with RBCT: any medical complication (1.8; 1.1-3.0), major medical complications (2.1; 1.2-3.7), any infection (2.8; 1.7-4.5), pneumonia (2.6; 1.5-4.7), septicemia (2.9; 1.2-6.8), and need for mechanical ventilation (2.8; 1.5-5.1).
These data suggest that RBCTs are associated with medical complications after SAH. However, the data do not infer causation, and further study is necessary to better define the indications for transfusion after SAH.
在一般内科和外科患者中，红细胞输血（RBCT）与医疗并发症相关。我们检验了这样一个假设，即在重症监护病房（ICU）治疗期间进行 RBCT 与蛛网膜下腔出血（SAH）后发生医疗并发症相关。
我们回顾性分析了一个包含 421 例 SAH 患者的前瞻性观察数据库（平均年龄 51.5 岁，标准差 14.6 岁）。使用逻辑回归模型调整年龄、入院时血红蛋白（Hgb）、临床分级、平均 ICU Hgb 和症状性血管痉挛。
214 例患者在 ICU 期间接受了 RBCT。156 例患者发生了医疗并发症，接受输血的患者（46%）比未接受输血的患者（29.8%）更常见（P<.001）。111 例患者发生主要医疗并发症（心脏、肺部、肾脏或肝脏），45 例患者发生轻微并发症（如皮疹、深静脉血栓形成）。任何非中枢神经系统感染（n=183；P<.001），包括肺炎（n=103；P<.001）或败血症（n=36；P=.02），在接受 RBCT 的患者中更为常见。中枢神经系统感染（脑膜炎、颅伤口，n=15）也与 RBCT 相关（P=.03）。与未接受 RBCT 的患者相比，需要机械通气的患者（n=259）更有可能接受 RBCT（P<.001）。当使用逻辑回归来控制年龄、入院时临床分级和 Hgb、平均 ICU Hgb、症状性血管痉挛以及与结果相关的其他入院变量时，以下因素（比值比；95%置信区间）与 RBCT 相关：任何医疗并发症（1.8；1.1-3.0）、主要医疗并发症（2.1；1.2-3.7）、任何感染（2.8；1.7-4.5）、肺炎（2.6；1.5-4.7）、败血症（2.9；1.2-6.8）和需要机械通气（2.8；1.5-5.1）。
这些数据表明，在 SAH 后，RBCT 与医疗并发症相关。然而，这些数据并未推断出因果关系，需要进一步研究以更好地定义 SAH 后输血的适应证。
