描述术后输血相关急性肺损伤的流行病学特征。
Characterizing the epidemiology of postoperative transfusion-related acute lung injury.
机构信息
From the Department of Internal Medicine (L.C.) Department of Anesthesiology (Q.J., A.S., G.A.W., D.J.K.), Division of Pulmonary and Critical Care Medicine (H.Y.), Department of Information Technology (S.P.M.), and Division of Biomedical Statistics and Informatics (J.P., D.R.S.), Mayo Clinic, Rochester, Minnesota.
出版信息
Anesthesiology. 2015 Jan;122(1):12-20. doi: 10.1097/ALN.0000000000000514.
BACKGROUND
Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-related death in the United States; however, it remains poorly characterized in surgical populations. To better inform perioperative transfusion practice, and to help mitigate perioperative TRALI, the authors aimed to better define its epidemiology before and after TRALI mitigation strategies were introduced.
METHODS
This retrospective cohort study examined outcomes of adult patients undergoing noncardiac surgery with general anesthesia who received intraoperative transfusions during 2004 (n = 1,817) and 2011 (n = 1,562). The demographics and clinical characteristics of transfusion recipients, blood transfusion descriptors, and combined TRALI/possible TRALI incidence rates were evaluated. Univariate analyses were used to compare associations between patient characteristics, transfusion details, and TRALI mitigation strategies with TRALI/possible TRALI incidence rates in a before-and-after study design.
RESULTS
The incidence of TRALI/possible TRALI was 1.3% (23 of 1,613) in 2004 versus 1.4% (22 of 1,562) in 2011 (P = 0.72), with comparable overall rates in males versus females (1.4% [23 of 1,613] vs. 1.2% [22 of 1,766]) (P = 0.65). Overall, thoracic (3.0% [4 of 133]), vascular (2.7% [10 of 375]), and transplant surgeries (2.2% [4 of 178]) carried the highest rates of TRALI/possible TRALI. Obstetric and gynecologic surgical patients had no TRALI episodes. TRALI/possible TRALI incidence increased with larger volumes of blood product transfused (P < 0.001).
CONCLUSIONS
Perioperative TRALI/possible TRALI is more common than previously reported and its risk increases with greater volumes of blood component therapies. No significant reduction in the combined incidence of TRALI/possible TRALI occurred between 2004 and 2011, despite the introduction of TRALI mitigation strategies. Future efforts to identify specific risk factors for TRALI/possible TRALI in surgical populations may reduce the burden of this life-threatening complication.
背景
输血相关急性肺损伤（TRALI）是美国输血相关死亡的主要原因；然而，它在外科人群中的特征仍不清楚。为了更好地指导围手术期输血实践，并帮助减轻围手术期 TRALI，作者旨在在引入 TRALI 缓解策略之前和之后更好地定义其流行病学。
方法
这项回顾性队列研究检查了接受全身麻醉下非心脏手术的成年患者的结果，这些患者在 2004 年（n=1817）和 2011 年（n=1562）期间接受了术中输血。评估了输血接受者的人口统计学和临床特征、输血描述符以及合并 TRALI/可能 TRALI 的发生率。在前后研究设计中，使用单变量分析比较了患者特征、输血细节和 TRALI 缓解策略与 TRALI/可能 TRALI 发生率之间的关联。
结果
2004 年 TRALI/可能 TRALI 的发生率为 1.3%（23/1613），2011 年为 1.4%（22/1562）（P=0.72），男性与女性的总体发生率相似（1.4%[23/1613]与 1.2%[22/1766]）（P=0.65）。总体而言，胸部（3.0%[4/133]）、血管（2.7%[10/375]）和移植手术（2.2%[4/178]）的 TRALI/可能 TRALI 发生率最高。妇产科手术患者没有 TRALI 发作。TRALI/可能 TRALI 的发生率随着输血量的增加而增加（P<0.001）。
结论
围手术期 TRALI/可能 TRALI 比以前报告的更为常见，并且随着血液成分治疗量的增加，其风险增加。尽管引入了 TRALI 缓解策略，但 2004 年至 2011 年期间，合并 TRALI/可能 TRALI 的发生率没有显著降低。未来努力确定外科人群中 TRALI/可能 TRALI 的特定危险因素可能会降低这种危及生命的并发症的负担。
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