Mirzaei Sahereh, Hershberger Patricia E, DeVon Holli A
Sahereh Mirzaei is a doctoral student at the University of Illinois at Chicago, and a clinical practitioner in the open heart intensive care unit, University of Illinois at Chicago, College of Nursing, Chicago, Illinois.
Patricia Hershberger is the doctoral instructor for the Developing Literature Reviews course at the University of Illinois at Chicago.
Crit Care Nurse. 2019 Feb;39(1):26-35. doi: 10.4037/ccn2019589.
Bleeding is a serious complication of coronary artery bypass grafting that often leads to blood transfusion. Approximately 50% of patients who have the surgery receive blood products, and blood transfusions play a role in adverse outcomes after the surgery.
To examine the association between perioperative blood transfusion and postoperative adverse outcomes in patients undergoing coronary artery bypass grafting.
A systematic review of the literature, via the matrix method of quality evaluation, was conducted. PubMed, CINAHL, and Science Direct databases for 2000 through 2016 were searched. Inclusion criteria were articles published in English and original research related to clinical outcomes of blood transfusion after coronary artery bypass grafting. Seventeen articles were included in the review.
Mortality, both short- and long-term, was significantly higher in transfusion patients than in nontransfusion patients. Patients with transfusion of red blood cells had higher resource utilization and more complications, including infection, pneumonia, renal failure, graft occlusion, and atrial fibrillation, than did nontransfusion patients.
An association exists between red blood cell transfusions and adverse clinical outcomes for patients undergoing coronary artery bypass grafting. Transfusion of red blood cells is sometimes unnecessary, may be injurious, and should be used cautiously. Even a single-unit increase in perioperative red blood cell transfusions can have a significant adverse impact on outcomes. Individual benefits and risks should be weighed before transfusion to avoid adverse outcomes. Transfusion guidelines should be reviewed to include the latest evidence to guarantee the most appropriate use of blood products.
出血是冠状动脉旁路移植术的一种严重并发症，常导致输血。约50%接受该手术的患者会接受血液制品，且输血在术后不良结局中起一定作用。
探讨冠状动脉旁路移植术患者围手术期输血与术后不良结局之间的关联。
通过质量评估矩阵法对文献进行系统综述。检索了2000年至2016年的PubMed、CINAHL和Science Direct数据库。纳入标准为以英文发表的文章以及与冠状动脉旁路移植术后输血临床结局相关的原始研究。该综述纳入了17篇文章。
输血患者的短期和长期死亡率均显著高于未输血患者。与未输血患者相比，输注红细胞的患者资源利用率更高，并发症更多，包括感染、肺炎、肾衰竭、移植物闭塞和心房颤动。
冠状动脉旁路移植术患者红细胞输血与不良临床结局之间存在关联。红细胞输血有时并无必要，可能有害，应谨慎使用。即使围手术期红细胞输血量仅增加一个单位也可能对结局产生显著不利影响。输血前应权衡个体的获益与风险以避免不良结局。应审查输血指南以纳入最新证据，确保血液制品的最恰当使用。
