1Department of Neurological Surgery and.
2Brain and Spinal Injury Center, University of California, San Francisco, California.
J Neurosurg. 2018 May;128(5):1530-1537. doi: 10.3171/2017.1.JNS162234. Epub 2017 Jun 23.
OBJECTIVE Blood loss and moderate anemia are common in patients with traumatic brain injury (TBI). However, despite evidence of the ill effects and expense of the transfusion of packed red blood cells, restrictive transfusion practices have not been universally adopted for patients with TBI. At a Level I trauma center, the authors compared patients with TBI who were managed with a restrictive (target hemoglobin level > 7 g/dl) versus a liberal (target hemoglobin level > 10 g/dl) transfusion protocol. This study evaluated the safety and cost-efficiency of a hospital-wide change to a restrictive transfusion protocol. METHODS A retrospective analysis of patients with TBI who were admitted to the intensive care unit (ICU) between January 2011 and September 2015 was performed. Patients < 16 years of age and those who died within 24 hours of admission were excluded. Demographic data and injury characteristics were compared between groups. Multivariable regression analyses were used to assess hospital outcome measures and mortality rates. Estimates from an activity-based cost analysis model were used to detect changes in cost with transfusion protocol. RESULTS A total of 1565 patients with TBI admitted to the ICU were included in the study. Multivariable analysis showed that a restrictive transfusion strategy was associated with fewer days of fever (p = 0.01) and that patients who received a transfusion had a larger fever burden. ICU length of stay, ventilator days, incidence of lung injury, thromboembolic events, and mortality rates were not significantly different between transfusion protocol groups. A restrictive transfusion protocol saved approximately $115,000 annually in hospital direct and indirect costs. CONCLUSIONS To the authors' knowledge, this is the largest study to date to compare transfusion protocols in patients with TBI. The results demonstrate that a hospital-wide change to a restrictive transfusion protocol is safe and cost-effective in patients with TBI.
创伤性脑损伤（TBI）患者常出现失血和中度贫血。然而，尽管有证据表明输血会带来不良影响和费用，但对于 TBI 患者，限制性输血方案并未被普遍采用。在一家一级创伤中心，作者比较了采用限制性（目标血红蛋白水平>7g/dl）与宽松性（目标血红蛋白水平>10g/dl）输血方案治疗的 TBI 患者。本研究评估了在全院范围内采用限制性输血方案的安全性和成本效益。
对 2011 年 1 月至 2015 年 9 月期间入住重症监护病房（ICU）的 TBI 患者进行回顾性分析。排除年龄<16 岁和入院后 24 小时内死亡的患者。比较两组患者的人口统计学数据和损伤特征。采用多变量回归分析评估医院转归指标和死亡率。采用基于活动的成本分析模型估算输血方案改变所致的成本变化。
共纳入 1565 例 ICU 收治的 TBI 患者。多变量分析显示，限制性输血策略与发热天数减少（p=0.01）相关，且接受输血的患者发热负担更大。输血方案两组患者 ICU 住院时间、呼吸机使用时间、肺损伤发生率、血栓栓塞事件发生率和死亡率无显著差异。采用限制性输血方案可每年节省约 11.5 万美元的医院直接和间接成本。
据作者所知，这是迄今为止比较 TBI 患者输血方案的最大规模研究。结果表明，在 TBI 患者中实施全院范围的限制性输血方案既安全又具有成本效益。
