Department of Surgery, University of California, Davis, Medical Center, Sacramento, California 95817, USA.
J Neurotrauma. 2011 Jan;28(1):155-65. doi: 10.1089/neu.2010.1451. Epub 2010 Dec 2.
Anemia is recognized as a possible cause of secondary injury following traumatic brain injury (TBI). Cogent arguments can be made for both liberal and restrictive blood transfusion practices in this setting. In this narrative review, we summarize available knowledge regarding the risks of anemia and transfusion in patients with TBI. Laboratory studies using animal models and healthy human subjects suggest that anemia below a hemoglobin (Hb) concentration of 7 g/dL results in impaired brain function and below 10 g/dL may be detrimental to recovery from TBI. Clinical studies that have evaluated the association of anemia with clinical outcomes have not consistently demonstrated harm, but they generally have important methodological weaknesses. Alternatively, studies that have analyzed transfusion as a predictor of worse outcome have consistently identified such an association, but these studies may involve residual confounding. What little information exists from randomized trials that have included patients with TBI and evaluated liberal versus restrictive transfusion strategies is inconclusive. Since anemia in the setting of TBI is relatively common and there is considerable variation in transfusion preferences, greater study of this topic - preferably with one or more rigorous, adequately powered, non-inferiority randomized trials - is desirable.
贫血被认为是创伤性脑损伤 (TBI) 后继发性损伤的一个可能原因。在这种情况下，对于输血的宽松和严格实践都有充分的论据。在这篇叙述性综述中，我们总结了有关 TBI 患者贫血和输血风险的现有知识。使用动物模型和健康人体受试者的实验室研究表明，血红蛋白 (Hb) 浓度低于 7 g/dL 的贫血会导致脑功能受损，而 Hb 浓度低于 10 g/dL 可能不利于 TBI 的恢复。评估贫血与临床结局之间关联的临床研究并未一致表明存在危害，但它们通常存在重要的方法学缺陷。另一方面，分析输血作为预后不良预测因素的研究一致确定了这种关联，但这些研究可能涉及残留混杂因素。来自纳入 TBI 患者并评估宽松与严格输血策略的随机试验的少量信息尚无定论。由于 TBI 患者中贫血较为常见，且输血偏好存在较大差异，因此需要对此问题进行更多研究-最好进行一项或多项严格、充分有力、非劣效性的随机试验。
