Department of Pediatrics, Golisano Children's Hospital at Strong, University of Rochester Medical Center, Rochester, NY, USA.
Pediatr Crit Care Med. 2011 Jan;12(1):39-45. doi: 10.1097/PCC.0b013e3181e329db.
To examine the impact of a restrictive vs. liberal transfusion strategy on arterial lactate and oxygen content differences in children with single-ventricle physiology post cavopulmonary connection. Children with single-ventricle physiology are routinely transfused postoperatively to increase systemic oxygen delivery, and transfusion thresholds in this population have not been studied.
Prospective, randomized, controlled, clinical trial.
Pediatric cardiac intensive care unit in a teaching hospital.
Infants and children (n = 60) with variations of single-ventricle physiology presenting for cavopulmonary connection.
Subjects were randomized to a restrictive (hemoglobin of < 9.0 g/dL), or liberal (hemoglobin of ≥ 13.0 g/dL) transfusion strategy for 48 hrs post operation. Primary outcome measures were mean and peak arterial lactate. Secondary end points were arteriovenous (C(a-v)o2) and arteriocerebral oxygen content (C(a-c)o2) differences and clinical outcomes.
A total of 30 children were in each group. There were no significant preoperative differences. Mean hemoglobin in the restrictive and liberal groups were 11 ± 1.3 g/dL and 13.9 ± 0.5 g/dL, respectively (p < .01). No differences in mean (1.4 ± 0.5 mmol/L [Restrictive] vs. 1.4 ± 0.4 mmol/L [Liberal]) or peak (3.1 ± 1.5 mmol/L [Restrictive] vs. 3.2 ± 1.3 mmol/L [Liberal]) lactate between groups were found. Mean number of red blood cell transfusions were 0.43 ± 0.6 and 2.1 ± 1.2 (p < .01), and donor exposure was 1.2 ± 0.7 and 2.4 ± 1.1 to (p < .01), for each group, respectively. No differences were found in C(a-v)o2, C(a-c)o2, or clinical outcome measures.
Children with single-ventricle physiology do not benefit from a liberal transfusion strategy after cavopulmonary connection. A restrictive red blood cell transfusion strategy decreases the number of transfusions, donor exposures, and potential risks in these children. Larger studies with clinical outcome measures are needed to determine the transfusion threshold for children post cardiac repair or palliation for congenital heart disease.
研究在腔静脉肺动脉吻合术后，单心室患儿采用限制输血策略与自由输血策略对动脉血乳酸和氧含量差异的影响。单心室患儿术后常规输血以增加全身氧输送，但该人群的输血阈值尚未得到研究。
前瞻性、随机、对照、临床试验。
教学医院儿科心脏重症监护病房。
接受腔静脉肺动脉吻合术的单心室患儿（n = 60）。
将患儿随机分为限制输血组（血红蛋白<9.0 g/dL）或自由输血组（血红蛋白≥13.0 g/dL），术后 48 小时内输血。主要观察指标为平均动脉血乳酸和峰值动脉血乳酸。次要终点为动静脉（C(a-v)o2）和动脑氧含量（C(a-c)o2）差异及临床结局。
每组各 30 例患儿。术前无显著差异。限制输血组和自由输血组的平均血红蛋白分别为 11±1.3 g/dL 和 13.9±0.5 g/dL（p<.01）。两组平均（1.4±0.5 mmol/L[限制输血组] vs. 1.4±0.4 mmol/L[自由输血组]）或峰值（3.1±1.5 mmol/L[限制输血组] vs. 3.2±1.3 mmol/L[自由输血组]）乳酸均无差异。平均红细胞输注量分别为 0.43±0.6 和 2.1±1.2（p<.01），供者暴露量分别为 1.2±0.7 和 2.4±1.1（p<.01）。两组间 C(a-v)o2、C(a-c)o2 或临床结局测量值均无差异。
单心室患儿在腔静脉肺动脉吻合术后不能从自由输血策略中获益。限制红细胞输血策略可减少此类患儿的输血次数、供者暴露量和潜在风险。需要进行更大规模的研究，以确定先天性心脏病心脏修复或姑息治疗后患儿的输血阈值。
