[早产儿浓缩红细胞输血与坏死性小肠结肠炎严重程度的关系]
[Relation between packed red blood cell transfusion and severity of necrotizing enterocolitis in premature infants].
作者信息
Couselo M, Aguar M, Ibáñez V, Mangas L, García-Sala C
机构信息
Hospital La Fe. Valencia.
出版信息
Cir Pediatr. 2011 Aug;24(3):137-41.
OBJECTIVE
It has been proposed recently that red blood cell transfusions (RBCT) might increase severity in infants with necrotizing enterocolitis (NEC). We intend to study if patients who have received red blood transfusions before the onset of NEC develop more severe forms of this entity.
METHODS
A retrospective study was carried out including prematures with NEC. Two groups were considered: with previous RBCT (TR) and without previous RBCT (No-TR). The main outcomes of the study were severity of NEC, according to the Bell stage (BS), surgical treatment and mortality. Patients who were treated with RBCT 48 hours prior to the onset of NEC symptoms were analysed separately afterwards. Comparison of groups was made with the Fisher test or the Chi square test for the BS, surgery, mortality and nominal variables; the U Mann-Whitney test was used for numeric variables.
RESULTS
Forty-six patients were included for the investigation (28 in TR and 18 in No-TR). In the TR Group 20/28 neonates reached a BS II; 8/28 BS III; 10 were operated on and there were 7 deaths. In the No-TR group 14/18 patients were classified as EB II; 4/18 as BS III, 3 patients needed surgery and Idied. No relation was found between RBCT and BS (p = 0.39), RBCT and surgery (RR = 2.7; CI 95%: 0.64-11.97; p = 0.19), or RBCT and mortality (RR = 4.5; CI 95%: 0.6-36.6; p = 0.09). In those patients who received a RBCT 48 hours before the initial symptoms there were 3 EB II and 3 EB III; 4 infants required surgical treatment and there were 2 exitus. Comparing this subgroup and the rest of the sample there were only significant differences in the need of surgical treatment: patients who received a RBCT 48 hours before the onset of NEC were at an increased risk for surgery of 2.6 (CI 95%: 1.2-5.1; p = 0.045) but there were not different when surgical treatment and mortality were considered.
CONCLUSIONS
These results do not support clearly the hypothesis that there is a relation between previous treatment with RBCT and the severity of NEC.
目的
最近有人提出，红细胞输血（RBCT）可能会加重坏死性小肠结肠炎（NEC）婴儿的病情严重程度。我们打算研究在NEC发病前接受过红细胞输血的患者是否会发展为该疾病更严重的形式。
方法
对患有NEC的早产儿进行了一项回顾性研究。考虑了两组：既往接受过RBCT的（TR组）和未接受过RBCT的（非TR组）。根据贝尔分期（BS）、手术治疗和死亡率来评估该研究的主要结果，即NEC的严重程度。对在NEC症状出现前48小时接受RBCT治疗的患者随后进行单独分析。对于BS、手术、死亡率和名义变量，采用Fisher检验或卡方检验进行组间比较；对于数值变量，采用曼-惠特尼U检验。
结果
46例患者纳入研究（TR组28例，非TR组18例）。TR组中，20/28例新生儿达到BS II期；8/28例为BS III期；10例行手术治疗，7例死亡。非TR组中，14/18例患者分类为BS II期；4/18例为BS III期，3例患者需要手术治疗，1例死亡。未发现RBCT与BS之间存在关联（p = 0.39），RBCT与手术之间也无关联（RR = 2. 在最初症状出现前48小时接受RBCT的患者中，有3例为BS II期，3例为BS III期；4例婴儿需要手术治疗，2例死亡。将该亚组与样本的其余部分进行比较，仅在手术治疗需求方面存在显著差异：在NEC发病前48小时接受RBCT的患者手术风险增加2.6倍（95%CI：1.2 - 5.1；p = 0.045），但在考虑手术治疗和死亡率时并无差异。
结论
这些结果并未明确支持既往接受RBCT治疗与NEC严重程度之间存在关联的假设。 7；CI 95%：0.64 - 11.97；p = 0.19），RBCT与死亡率之间也无关联（RR = 4.5；CI 95%：0.6 - 36.6；p = 0.09）。
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