Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, 200 Elizabeth Street, Toronto ON, M5G 2C4 Canada.
Br J Anaesth. 2017 Jun 1;118(6):843-851. doi: 10.1093/bja/aex090.
BACKGROUND.: Perioperative anaemia is common. Physicians believe that patients at increased cardiac risk do not tolerate anaemia and, consequently, these patients receive transfusions earlier and more often. This practice runs counter to a growing body of evidence that perioperative red blood cell (RBC) transfusion is harmful The aims of this study were as follows: (i) to assess the effects of transfusion at moderate to severely low ranges of postoperative haemoglobin concentrations; and (ii) to assess whether transfusion was beneficial in patients at high cardiac risk within these haemoglobin ranges.
METHODS.: A single-centre retrospective cohort study enrolled 75 719 consecutive major, non-cardiac surgery patients. Multivariable logistic regressions with 98.4% confidence intervals looking at specific nadir postoperative haemoglobin groups were compared to examine the effects of anaemia, RBC transfusion, and cardiac risk on postoperative 30 day in-hospital mortality.
RESULTS.: Patients at moderate to high cardiac risk had a two-fold greater prevalence of preoperative anaemia. In unadjusted analysis, RBC transfusion was associated with increased mortality at all transfusion thresholds in all patients. After adjustment, RBC transfusion in patients with high cardiac risk was associated with decreased mortality when the postoperative haemoglobin concentration was <80 g litre -1 [odds ratio 0.37 (98.4% confidence interval 0.17-0.77)].
CONCLUSIONS.: High cardiac risk was associated with increased incidence of anaemia, transfusion, and mortality. Red blood cell transfusion is associated with reduced mortality only in high cardiac risk patients with nadir postoperative haemoglobin concentration <80 g litre -1 . Transfusion, the main treatment for postoperative anaemia, does not appear to be associated with reduced postoperative mortality at higher nadir haemoglobin ranges.
围手术期贫血很常见。医生认为，心脏风险增加的患者不能耐受贫血，因此这些患者更早且更频繁地接受输血。这种做法与越来越多的证据相悖，这些证据表明围手术期红细胞（RBC）输血是有害的。本研究的目的如下：（i）评估在术后血红蛋白浓度中度至重度低范围内输血的效果；（ii）评估在这些血红蛋白范围内心脏风险较高的患者输血是否有益。
一项单中心回顾性队列研究纳入了 75719 例连续的主要非心脏手术患者。使用 98.4%置信区间的多变量逻辑回归比较了特定术后最低血红蛋白组，以检查贫血、RBC 输血和心脏风险对术后 30 天住院内死亡率的影响。
中度至高度心脏风险的患者术前贫血患病率更高。在未调整的分析中，在所有患者中，在所有输血阈值下，RBC 输血与死亡率增加相关。调整后，当术后血红蛋白浓度<80g/L 时，高心脏风险患者的 RBC 输血与死亡率降低相关[比值比 0.37（98.4%置信区间 0.17-0.77)]。
高心脏风险与贫血、输血和死亡率的发生率增加相关。只有当术后血红蛋白浓度<80g/L 时，RBC 输血才与高心脏风险患者的死亡率降低相关。输血是治疗术后贫血的主要方法，但在较高的最低血红蛋白范围内似乎与术后死亡率降低无关。
