手术肿瘤患者的输血需求：一项前瞻性、随机对照试验。

Transfusion requirements in surgical oncology patients: a prospective, randomized controlled trial.

机构信息

From the Surgical Intensive Care Unit and Department of Anesthesiology, Cancer Institute, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil (J.P.d.A., F.R.B.G.G., E.P.M.d.A., J.T.F., E.A.O., F.B., C.L.P., R.E.N., S.M.R.F., J.I.A., M.B., S.V., A.C.V.S., H.P., R.K.F., J.O.C.A., L.A.H.); Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium (J.-L.V.); Department of Intensive Care Medicine, St. George's Healthcare NHS Trust, London, United Kingdom (A.R.); Department of Surgery, Cancer Institute, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil (G.C., U.R., A.C., M.D.); and Department of Oncology, Cancer Institute, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil (M.d.P.E.D.).

出版信息

Anesthesiology. 2015 Jan;122(1):29-38. doi: 10.1097/ALN.0000000000000511.

DOI:10.1097/ALN.0000000000000511

PMID:25401417

Abstract

BACKGROUND

Several studies have indicated that a restrictive erythrocyte transfusion strategy is as safe as a liberal one in critically ill patients, but there is no clear evidence to support the superiority of any perioperative transfusion strategy in patients with cancer.

METHODS

In a randomized, controlled, parallel-group, double-blind (patients and outcome assessors) superiority trial in the intensive care unit of a tertiary oncology hospital, the authors evaluated whether a restrictive strategy of erythrocyte transfusion (transfusion when hemoglobin concentration <7 g/dl) was superior to a liberal one (transfusion when hemoglobin concentration <9 g/dl) for reducing mortality and severe clinical complications among patients having major cancer surgery. All adult patients with cancer having major abdominal surgery who required postoperative intensive care were included and randomly allocated to treatment with the liberal or the restrictive erythrocyte transfusion strategy. The primary outcome was a composite endpoint of mortality and morbidity.

RESULTS

A total of 198 patients were included as follows: 101 in the restrictive group and 97 in the liberal group. The primary composite endpoint occurred in 19.6% (95% CI, 12.9 to 28.6%) of patients in the liberal-strategy group and in 35.6% (27.0 to 45.4%) of patients in the restrictive-strategy group (P = 0.012). Compared with the restrictive strategy, the liberal transfusion strategy was associated with an absolute risk reduction for the composite outcome of 16% (3.8 to 28.2%) and a number needed to treat of 6.2 (3.5 to 26.5).

CONCLUSION

A liberal erythrocyte transfusion strategy with a hemoglobin trigger of 9 g/dl was associated with fewer major postoperative complications in patients having major cancer surgery compared with a restrictive strategy.

摘要

背景

几项研究表明，在危重症患者中，限制输血策略与宽松输血策略一样安全，但没有明确的证据支持任何围手术期输血策略在癌症患者中具有优越性。

方法

在一家三级肿瘤医院的重症监护病房进行的一项随机、对照、平行组、双盲（患者和结局评估者）优效性试验中，作者评估了红细胞输血的限制策略（血红蛋白浓度<7 g/dl 时输血）是否优于宽松策略（血红蛋白浓度<9 g/dl 时输血），以降低接受重大癌症手术的患者的死亡率和严重临床并发症。所有需要术后重症监护的接受重大腹部手术的成年癌症患者均被纳入并随机分配至宽松或限制红细胞输血策略治疗组。主要结局是死亡率和发病率的复合终点。

结果

共有 198 例患者入组，分别为限制组 101 例，宽松组 97 例。宽松策略组中有 19.6%（95%CI，12.9 至 28.6%）的患者发生主要复合终点，限制策略组中有 35.6%（27.0 至 45.4%）的患者发生该事件（P=0.012）。与限制策略相比，宽松输血策略使复合结局的绝对风险降低 16%（3.8 至 28.2%），需要治疗的人数为 6.2（3.5 至 26.5）。