Duan Zhi Xiang, Chen Dong Xu, Yang Bao Zhong, Zhang Xuan Qiang
Department of Anesthesiology, Yuncheng Central Hospital, Yuncheng, Shanxi, 044000, P.R. China.
Department of Anesthesiology, West China Hospital, Sichuan University, No. 37 Wainan Guoxue Rd, Chengdu, Sichuan, 610041, P.R. China.
Pediatr Cardiol. 2021 Aug;42(6):1241-1251. doi: 10.1007/s00246-021-02644-8. Epub 2021 May 28.
This study aimed to compare the effects of restrictive and liberal red blood cell (RBC) transfusion strategies on pediatric patients undergoing cardiac surgery, including cyanotic and non-cyanotic children. A literature search of the MEDLINE, EMBASE, PubMed, and the Cochrane Library database was conducted. Meta-analyses were carried out comparing restrictive and liberal transfusion strategies. Subgroup analyses were performed based on the basis of cyanotic status. Five randomized controlled trials with a total of 497 children were included. There was no significant difference in the risk of in-hospital mortality between the two transfusion strategies (risk ratio 1.21; 95% confidence interval 0.49 to 2.99; P = 0.68). The trial sequential analysis suggested that the current meta-analysis had an absence of evidence for in-hospital mortality, and the data were insufficient. Moreover, no significant differences existed between groups in terms of risk of infection, blood loss, duration of mechanical ventilation, pediatric intensive care unit (PICU) stay duration, or hospital stay duration. Cyanotic children treated with a liberal transfusion strategy had a shorter ventilator duration, but the transfusion strategy did not affect in-hospital mortality, infection, hospital stay, or PICU stay duration. On the basis of the available data, our analysis indicates that a liberal transfusion strategy did not lead to a better outcomes, but the data are extremely sparse, which highlights the need for clearer transfusion guidelines specific to this specific population.Trial registration number CRD42018102283.
本研究旨在比较限制性和宽松性红细胞（RBC）输血策略对接受心脏手术的儿科患者的影响，包括青紫型和非青紫型儿童。对MEDLINE、EMBASE、PubMed和Cochrane图书馆数据库进行了文献检索。进行了荟萃分析以比较限制性和宽松性输血策略。根据青紫状态进行亚组分析。纳入了五项随机对照试验，共497名儿童。两种输血策略在院内死亡风险方面无显著差异（风险比1.21；95%置信区间0.49至2.99；P = 0.68）。试验序贯分析表明，当前的荟萃分析缺乏关于院内死亡的证据，且数据不足。此外，在感染风险、失血量、机械通气持续时间、儿科重症监护病房（PICU）住院时间或住院时间方面，各组之间没有显著差异。采用宽松输血策略治疗的青紫型儿童呼吸机使用时间较短，但输血策略并未影响院内死亡率、感染、住院时间或PICU住院时间。根据现有数据，我们的分析表明，宽松输血策略并未带来更好的结果，但数据极为稀少，这凸显了针对这一特定人群制定更明确输血指南的必要性。试验注册号CRD42018102283。
