Department of Neurology, University of Texas Southwestern Medical Center, Parkland Memorial Hospital, Dallas, Texas, USA.
J Neurosurg. 2010 Sep;113(3):539-46. doi: 10.3171/2009.12.JNS091337.
In this paper, the authors' goal was to examine the relationship between transfusion and long-term functional outcomes in moderately anemic patients (lowest hematocrit [HCT] level 21-30%) with traumatic brain injury (TBI). While evidence suggests that transfusions are associated with poor hospital outcomes, no study has examined transfusions and long-term functional outcomes in this population. The preferred transfusion threshold remains controversial.
The authors performed a retrospective review of patients who were admitted with TBI between September 2005 and November 2007, extracting data such as HCT level, status of red blood cell transfusion, admission Glasgow Coma Scale (GCS) score, serum glucose, and length of hospital stay. Outcome measures assessed at 6 months were Glasgow Outcome Scale-Extended score, Functional Status Examination score, and patient death. A multivariate generalized linear model controlling for confounding variables was used to assess the association between transfusion and outcome.
During the study period, 292 patients were identified, and 139 (47.6%) met the criteria for moderate anemia. Roughly half (54.7%) underwent transfusions. Univariate analyses showed significant correlations between outcome score and patient age, admission GCS score, head Abbreviated Injury Scale score, number of days with an HCT level < 30%, highest glucose level, number of days with a glucose level > 200 mg/dl, length of hospital stay, number of patients receiving a transfusion, and transfusion volume. In multivariate analysis, admission GCS score, receiving a transfusion, and transfusion volume were the only variables associated with outcome (F = 2.458, p = 0.007; F = 11.694, p = 0.001; and F = 1.991, p = 0.020, respectively). There was no association between transfusion and death.
Transfusions may contribute to poor long-term functional outcomes in anemic patients with TBI. Transfusion strategies should be aimed at patients with symptomatic anemia or physiological compromise, and transfusion volume should be minimized.
本文作者旨在研究创伤性脑损伤（TBI）伴中度贫血患者（最低红细胞压积[HCT]水平 21-30%）输血与长期功能结局的关系。虽然有证据表明输血与不良住院结局相关，但尚无研究对此人群的输血与长期功能结局进行探讨。最佳输血阈值仍存在争议。
作者对 2005 年 9 月至 2007 年 11 月间因 TBI 入院的患者进行回顾性分析，提取的资料包括 HCT 水平、红细胞输血状态、入院格拉斯哥昏迷量表（GCS）评分、血清葡萄糖及住院时间。在 6 个月时评估的预后指标包括格拉斯哥结局量表-扩展评分、功能状态检查评分和患者死亡。采用多变量广义线性模型控制混杂因素，以评估输血与结局之间的关系。
在研究期间，共确定 292 例患者，其中 139 例（47.6%）符合中度贫血标准。约有一半（54.7%）患者接受了输血。单变量分析显示，预后评分与患者年龄、入院 GCS 评分、头部简明损伤量表评分、HCT 水平<30%的天数、最高葡萄糖水平、葡萄糖水平>200mg/dl 的天数、住院时间、接受输血的患者数量及输血体积等均存在显著相关性。多变量分析显示，入院 GCS 评分、输血及输血体积是与结局相关的唯一变量（F=2.458，p=0.007；F=11.694，p=0.001；F=1.991，p=0.020）。输血与死亡之间无相关性。
输血可能导致 TBI 伴贫血患者的长期功能结局较差。输血策略应针对有症状性贫血或生理性受损的患者，并应尽量减少输血体积。
