Division of Anesthesiology, UMC Utrecht, Q 04.2.313, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands,
Ann Hematol. 2013 Dec;92(12):1701-6. doi: 10.1007/s00277-013-1832-z. Epub 2013 Jul 7.
Stored red blood cells undergo progressive structural and functional changes over time. Recently, concerns have been raised about the transfusion of older red blood cell (RBC) concentrates after cardiac surgery. The objective of the study was to test the hypothesis that longer storage time of RBCs increases the risk of adverse outcome after cardiac surgery. This is a retrospective cohort study which includes patients who underwent coronary artery bypass surgery and/or valve surgery. All patients were operated in the period from September 2006 to December 2010 and received 1 to 6 units of RBCs intraoperative or after surgery. Patients were divided into two groups according to the storage time of the RBCs. The "younger" group comprised patients who received RBCs ≤14 days old (n = 111) and the "any older" group comprised patients who received RBCs >14 days old (n = 710). Using univariable and multivariable regression analysis, we examined the effect of storage time on the primary composite endpoint of death, myocardial infarction, and stroke (major adverse cardiovascular events). Secondary outcomes were prolonged ICU and hospital stay. Data of 821 patients who received a total of 2,004 RBCs were analyzed. The median storage time for the younger group was 13 ± 2 days, the median storage time for the "any older" group was 21 ± 5 days. The incidence of the primary outcome was 8.6 % in the "any older" group and 4.5 % in the younger group (adjusted odds ratio (OR) 1.68; 95 % confidence interval (CI), 0.65-4.34). Prolonged ICU stay was 12.3 % in the "any older" group and 6.3 % in the younger group (adjusted OR 1.58; 95 % CI, 0.69-3.66). In patients undergoing cardiac surgery, transfusion of RBCs stored for more than 2 weeks was not associated with adverse outcomes.
储存的红细胞随着时间的推移会发生渐进性的结构和功能变化。最近，人们对心脏手术后输注较陈旧的红细胞（RBC）浓缩物的安全性提出了担忧。本研究旨在检验以下假设，即 RBC 储存时间延长会增加心脏手术后不良结局的风险。这是一项回顾性队列研究，纳入了接受冠状动脉旁路移植术和/或瓣膜手术的患者。所有患者均于 2006 年 9 月至 2010 年 12 月期间接受手术，并在术中或术后输注 1 至 6 单位 RBC。根据 RBC 的储存时间将患者分为两组。“年轻”组包含输注 ≤14 天龄 RBC 的患者（n = 111），“任何较老”组包含输注 >14 天龄 RBC 的患者（n = 710）。采用单变量和多变量回归分析，我们检验了储存时间对死亡、心肌梗死和中风（主要不良心血管事件）这一主要复合终点的影响。次要结局为 ICU 和住院时间延长。共分析了 821 例患者的 2004 单位 RBC 的数据。“年轻”组的中位储存时间为 13 ± 2 天，“任何较老”组的中位储存时间为 21 ± 5 天。“任何较老”组的主要结局发生率为 8.6%，“年轻”组为 4.5%（调整后的比值比（OR）为 1.68；95%置信区间（CI）为 0.65-4.34）。“任何较老”组 ICU 入住时间延长的发生率为 12.3%，“年轻”组为 6.3%（调整后的 OR 为 1.58；95%CI 为 0.69-3.66）。在接受心脏手术的患者中，输注储存时间超过 2 周的 RBC 与不良结局无关。
