颅脑外伤后的输血需求：一项随机可行性对照试验。
Transfusion requirements after head trauma: a randomized feasibility controlled trial.
机构信息
Internal Medicine, Hospital São Rafael, Salvador, Brazil.
Intensive Care Unit, Hospital da Cidade, Salvador, Brazil.
出版信息
Crit Care. 2019 Mar 12;23(1):89. doi: 10.1186/s13054-018-2273-9.
BACKGROUND
Anemia is frequent among patients with traumatic brain injury (TBI) and is associated with an increased risk of poor outcome. The optimal hemoglobin concentration to trigger red blood cell (RBC) transfusion in patients with TBI is not clearly defined.
METHODS
All eligible consecutive adult patients admitted to the intensive care unit (ICU) with moderate or severe TBI were randomized to a "restrictive" (hemoglobin transfusion threshold of 7 g/dL), or a "liberal" (threshold 9 g/dL) transfusion strategy. The transfusion strategy was continued for up to 14 days or until ICU discharge. The primary outcome was the mean difference in hemoglobin between groups. Secondary outcomes included transfusion requirements, intracranial pressure management, cerebral hemodynamics, length of stay, mortality and 6-month neurological outcome.
RESULTS
A total of 44 patients were randomized, 21 patients to the liberal group and 23 to the restrictive group. There were no baseline differences between the groups. The mean hemoglobin concentrations during the 14-day period were 8.4 ± 1.0 and 9.3 ± 1.3 (p < 0.01) in the restrictive and liberal groups, respectively. Fewer RBC units were administered in the restrictive than in the liberal group (35 vs. 66, p = 0.02). There was negative correlation (r = - 0.265, p < 0.01) between hemoglobin concentration and middle cerebral artery flow velocity as evaluated by transcranial Doppler ultrasound and the incidence of post-traumatic vasospasm was significantly lower in the liberal strategy group (4/21, 3% vs. 15/23, 65%; p < 0.01). Hospital mortality was higher in the restrictive than in the liberal group (7/23 vs. 1/21; p = 0.048) and the liberal group tended to have a better neurological status at 6 months (p = 0.06).
CONCLUSIONS
The trial reached feasibility criteria. The restrictive group had lower hemoglobin concentrations and received fewer RBC transfusions. Hospital mortality was lower and neurological status at 6 months favored the liberal group.
TRIAL REGISTRATION
ClinicalTrials.gov, NCT02203292 . Registered on 29 July 2014.
背景
创伤性脑损伤（TBI）患者常发生贫血，并且与预后不良的风险增加相关。TBI 患者触发红细胞（RBC）输血的最佳血红蛋白浓度尚未明确界定。
方法
所有符合条件的连续成年 TBI 患者均被随机分配至“限制”（血红蛋白输血阈值为 7g/dL）或“宽松”（阈值为 9g/dL）输血策略组，入住重症监护病房（ICU）。输血策略持续至 14 天或直至 ICU 出院。主要结局为两组间的平均血红蛋白差异。次要结局包括输血需求、颅内压管理、脑血流动力学、住院时间、死亡率和 6 个月神经结局。
结果
共纳入 44 例患者，21 例患者进入宽松组，23 例进入限制组。两组患者基线无差异。限制组和宽松组在 14 天期间的平均血红蛋白浓度分别为 8.4±1.0 和 9.3±1.3（p<0.01）。限制组给予的 RBC 单位少于宽松组（35 与 66，p=0.02）。经颅多普勒超声评估大脑中动脉血流速度与血红蛋白浓度呈负相关（r=-0.265，p<0.01），宽松策略组创伤后血管痉挛的发生率显著较低（4/21，3%与 15/23，65%；p<0.01）。限制组的住院死亡率高于宽松组（7/23 与 1/21；p=0.048），6 个月时宽松组的神经状态更好（p=0.06）。
结论
该试验达到了可行性标准。限制组的血红蛋白浓度较低，输血次数较少。住院死亡率较低，宽松组 6 个月时的神经状态更好。
试验注册
ClinicalTrials.gov，NCT02203292。于 2014 年 7 月 29 日注册。
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