Hogervorst Esther K, Rosseel Peter M J, van de Watering Leo M G, Brand Anneke, Bentala M, van der Bom Johanna G, van der Meer Nardo J M
Center for Transfusion Research, Sanquin Research, Leiden, Netherlands; Jon J van Rood Center for Clinical Transfusion Research, Leiden University Medical Center, Leiden, Netherlands.
Amphia Hospital, Department of Anesthesia and Intensive Care, Breda, Netherlands.
J Cardiothorac Vasc Anesth. 2016 Apr;30(2):363-72. doi: 10.1053/j.jvca.2015.10.021. Epub 2015 Nov 2.
Increasing evidence suggests benefits from restrictive red blood cell transfusion (RBC) thresholds in major surgery and critically ill patients. However, these benefits are not obvious in cardiac surgery patients with intraoperative anemia. The authors examined the association between uncorrected hemoglobin (Hb) levels and selected postoperative outcomes as well as the effects of RBCs.
Cohort study with prospectively collected data from a cardiac surgery registry.
A major cardiac surgical hospital within the Netherlands, which is also a referral center for Jehovah's Witnesses.
Patients (23,860) undergoing cardiac surgery between 1997 and 2013.
Comparisons were done in patients with intraoperative nadir Hb<8 g/dL and/or an Hb decrease ≥ 50%. Comparison (A) between Jehovah's Witnesses (Witnesses) and matched non-Jehovah's Witnesses (non-Witnesses) transfused with 1 unit of RBC, and comparison (B) between patients given 1 unit of RBC intraoperatively versus matched non-transfused patients.
Postoperative outcomes were myocardial infarction, renal replacement therapy, stroke, and death. With propensity matching, the authors optimized exchangeability of the compared groups. Adverse outcomes increased with a decreasing Hb both among Witnesses and among non-Witnesses. The incidence of postoperative complications did not differ between Witnesses and matched non-Witnesses who received RBC (adjusted odds ratio 1.44, 95% confidence interval 0.63-3.29). Similarly, postoperative complications did not differ between patients who received a red cell transfusion and matched patients who did not (adjusted odds ratio 0.94, confidence interval 0.72-1.23).
Intraoperative anemia is associated with adverse outcomes after cardiac surgery, and a single RBC transfusion does not seem to influence these outcomes.
越来越多的证据表明，在大手术和危重症患者中采用限制性红细胞（RBC）输血阈值有益。然而，这些益处对于术中出现贫血的心脏手术患者并不明显。作者研究了未校正血红蛋白（Hb）水平与选定的术后结局之间的关联以及红细胞的影响。
一项队列研究，前瞻性收集来自心脏手术登记处的数据。
荷兰一家大型心脏外科医院，该医院也是耶和华见证人的转诊中心。
1997年至2013年间接受心脏手术的患者（23860例）。
对术中最低Hb<8 g/dL和/或Hb下降≥50%的患者进行比较。比较（A）接受1单位RBC输血的耶和华见证人（见证人）与匹配的非耶和华见证人（非见证人），以及比较（B）术中接受1单位RBC输血的患者与匹配的未输血患者。
术后结局包括心肌梗死、肾脏替代治疗、中风和死亡。通过倾向匹配，作者优化了比较组的可交换性。见证人组和非见证人组中，不良结局均随Hb水平降低而增加。接受RBC输血的见证人与匹配的非见证人之间术后并发症的发生率没有差异（校正比值比1.44，95%置信区间0.63 - 3.29）。同样，接受红细胞输血的患者与匹配的未输血患者之间术后并发症也没有差异（校正比值比0.94，置信区间0.72 - 1.23）。
术中贫血与心脏手术后的不良结局相关，单次RBC输血似乎不会影响这些结局。
