红细胞输注与肺部并发症：胸外科医师学会成人心脏外科学数据库分析。
Red Blood Cell Transfusion and Pulmonary Complications: The Society of Thoracic Surgeons Adult Cardiac Surgery Database Analysis.
机构信息
Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee.
出版信息
Ann Thorac Surg. 2024 Apr;117(4):839-846. doi: 10.1016/j.athoracsur.2023.12.012. Epub 2024 Jan 11.
BACKGROUND
Intraoperative packed red blood cell (PRBC) transfusion during cardiac surgery is associated with increased postoperative morbidity and mortality; however, data on the association between PRBC transfusion and postoperative pulmonary complications (PPCs) are somewhat conflicting. Using The Society of Thoracic Surgeons Adult Cardiac Surgery Database, we sought to determine whether intraoperative PRBC transfusion was associated with PPCs as well as with longer intensive care unit (ICU) stay after isolated coronary artery bypass grafting (CABG) surgery.
METHODS
A registry-based cohort study was performed on 751,893 patients with isolated CABG between January 1, 2015, to December 31, 2019. Using propensity score-weighted regression analysis, we analyzed the effect of intraoperative PRBC on the incidence of PPCs (hospital-acquired pneumonia [HAP], mechanical ventilation for >24 hours, or reintubation), ICU length of stay, and ICU readmission.
RESULTS
Transfusion of 1, 2, 3, and ≥4 units of PRBCs was associated with increased odds for HAP (odds ratios [ORs], 1.24 [95% CI, 1.21-1.26], 1.28 [95% CI, 1.26-1.32], 1.36 [95% CI, 1.33-1.39], 1.31 [95% CI, 1.28-1.34]), reintubation (ORs, 1.23 [95% CI, 1.21-1.25], 1.38 [95% CI, 1.35-1.40], 1.57 [95% CI, 1.55-1.60], 1.70 [95% CI, 1.67-1.73]), prolonged ventilation (ORs, 1.34 [95% CI, 1.33-1.36], 1.56 [95% CI, 1.53-1.58], 1.97 [95% CI, 1.94-2.00], 2.27 [95% CI, 2.24-2.30]), initial ICU length of stay (mean difference in hours, 6.79 [95% CI, 6.00-7.58], 9.55 [95% CI, 8.71-10.38], 17.26 [95% CI, 16.38-18.15], 22.14 [95% CI, 21.22-23.06]), readmission to ICU (ORs, 1.14 [95% CI, 1.12-1.64], 1.15 [95% CI, 1.12-1.17], 1.15 [95% CI, 1.13-1.18], 1.32 [95% CI, 1.29-1.35]), and additional ICU length of stay (mean difference in hours, 0.55 [95% CI, 0.18-0.92], 0.38 [95% CI, 0.00-0.77], 1.02 [95% CI, 0.61-1.43], 1.83 [95% CI, 1.40-2.26]), respectively.
CONCLUSIONS
Intraoperative PRBC transfusion was associated with increased incidence of PPCs, prolonged ICU stay, and ICU readmissions after isolated CABG surgery.
背景
心脏手术期间输注浓缩红细胞（PRBC）与术后发病率和死亡率增加相关；然而，关于 PRBC 输血与术后肺部并发症（PPCs）之间的关联的数据有些相互矛盾。使用胸外科医师学会成人心脏手术数据库，我们试图确定术中 PRBC 输血是否与 PPCs 以及与孤立性冠状动脉旁路移植术（CABG）后 ICU 住院时间延长相关。
方法
对 2015 年 1 月 1 日至 2019 年 12 月 31 日期间接受孤立性 CABG 的 751893 名患者进行基于登记的队列研究。使用倾向评分加权回归分析，我们分析了术中 PRBC 输血对 PPCs（医院获得性肺炎[HAP]、机械通气超过 24 小时或重新插管）、ICU 住院时间和 ICU 再入院的影响。
结果
输注 1、2、3 和≥4 单位的 PRBC 与 HAP（比值比[OR]，1.24[95%CI，1.21-1.26]、1.28[95%CI，1.26-1.32]、1.36[95%CI，1.33-1.39]、1.31[95%CI，1.28-1.34]）、重新插管（OR，1.23[95%CI，1.21-1.25]、1.38[95%CI，1.35-1.40]、1.57[95%CI，1.55-1.60]、1.70[95%CI，1.67-1.73]）、通气延长（OR，1.34[95%CI，1.33-1.36]、1.56[95%CI，1.53-1.58]、1.97[95%CI，1.94-2.00]、2.27[95%CI，2.24-2.30]）、初始 ICU 住院时间（小时平均差异，6.79[95%CI，6.00-7.58]、9.55[95%CI，8.71-10.38]、17.26[95%CI，16.38-18.15]、22.14[95%CI，21.22-23.06]）、ICU 再入院（OR，1.14[95%CI，1.12-1.64]、1.15[95%CI，1.12-1.17]、1.15[95%CI，1.13-1.18]、1.32[95%CI，1.29-1.35]）和 ICU 额外住院时间（小时平均差异，0.55[95%CI，0.18-0.92]、0.38[95%CI，0.00-0.77]、1.02[95%CI，0.61-1.43]、1.83[95%CI，1.40-2.26]）相关。
结论
术中 PRBC 输血与孤立性 CABG 手术后 PPCs 的发生率增加、ICU 住院时间延长和 ICU 再入院相关。
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