Pediatric Critical Care Unit, Sainte-Justine Hospital, Université de Montréal, Montreal, QC.
Ann Surg. 2010 Mar;251(3):421-7. doi: 10.1097/SLA.0b013e3181c5dc2e.
The optimal transfusion threshold after surgery in children is unknown. We analyzed the general surgery subgroup of the TRIPICU (Transfusion Requirements in Pediatric Intensive Care Units) study to determine the impact of a restrictive versus a liberal transfusion strategy on new or progressive multiple organ dysfunction syndrome (MODS).
The TRIPICU study, a prospective randomized controlled trial conducted in 17 centers, enrolled a total of 648 critically ill children with a hemoglobin equal to or below 9.5 g/dL within 7 days of pediatric intensive care unit (PICU) admission to receive prestorage leukocyte-reduced red-cell transfusion if their hemoglobin dropped below either 7.0 g/dL (restrictive) or 9.5 g/dL (liberal). A subgroup of 124 postoperative patients (60 randomized to restrictive and 64 to the liberal group) were analyzed. This study was registered at http://www.controlled-trials.com and carries the following ID ISRCTN37246456.
Participants in the restrictive and liberal groups were similar at randomization in age (restrictive vs. liberal: 53.5 +/- 51.8 vs. 73.7 +/- 61.8 months), severity of illness (pediatric risk of mortality [PRISM] score: 3.5 +/- 4.0 vs. 4.4 +/- 4.0), MODS (35% vs. 29%), need for mechanical ventilation (77% vs. 74%), and hemoglobin level (7.7 +/- 1.1 vs. 7.9 +/- 1.0 g/dL). The mean hemoglobin level remained 2.3 g/dL lower in the restrictive group after randomization. No significant differences were found for new or progressive MODS (8% vs. 9%; P = 0.83) or for 28-day mortality (2% vs. 2%; P = 0.96) in the restrictive versus liberal group. However, there was a statistically significant difference between groups for PICU length of stay (7.7 +/- 6.6 days for the restrictive group vs. 11.6 +/- 10.2 days for the liberal group; P = 0.03).
In this subgroup analysis of pediatric general surgery patients, we found no conclusive evidence that a restrictive red-cell transfusion strategy, as compared with a liberal one, increased the rate of new or progressive MODS or mortality.
儿童手术后的最佳输血阈值尚不清楚。我们分析了 TRIPICU（儿科重症监护病房输血需求）研究的普外科亚组，以确定限制输血策略与自由输血策略对新的或进行性多器官功能障碍综合征（MODS）的影响。
TRIPICU 研究是一项在 17 个中心进行的前瞻性随机对照试验，共纳入了 648 名危重症儿童，他们在进入儿科重症监护病房（PICU）后 7 天内血红蛋白等于或低于 9.5 g/dL，如果血红蛋白降至 7.0 g/dL（限制）或 9.5 g/dL（自由）以下，将接受储存前白细胞减少的红细胞输血。对 124 例术后患者（60 例随机分为限制组，64 例分为自由组）进行了亚组分析。这项研究在 http://www.controlled-trials.com 上注册，其注册号为 ISRCTN37246456。
在随机分组时，限制组和自由组的参与者在年龄（限制组 vs. 自由组：53.5 ± 51.8 岁 vs. 73.7 ± 61.8 岁）、疾病严重程度（儿科死亡率风险评分[PRISM]：3.5 ± 4.0 分 vs. 4.4 ± 4.0 分）、MODS（35% vs. 29%）、机械通气需求（77% vs. 74%）和血红蛋白水平（7.7 ± 1.1 g/dL vs. 7.9 ± 1.0 g/dL）方面相似。限制组在随机分组后平均血红蛋白水平仍低 2.3 g/dL。在新的或进行性 MODS（8% vs. 9%；P = 0.83）或 28 天死亡率（2% vs. 2%；P = 0.96）方面，限制组与自由组之间没有显著差异。然而，两组之间在儿科重症监护病房住院时间上存在统计学显著差异（限制组为 7.7 ± 6.6 天，自由组为 11.6 ± 10.2 天；P = 0.03）。
在这项儿科普外科患者的亚组分析中，我们没有发现确凿的证据表明，与自由输血策略相比，限制红细胞输血策略会增加新的或进行性 MODS 或死亡率的发生率。
