Yuan Xiang, Zhang Sen, Wan Jun, Chen Cheng, Wang Peng, Fan Shijie, Liu Yuyang, Yang Jingxian, Hou Jiayi, You Qiaoyu, Li Xiao, Li Kuilin, Xiang Ziyan, Rao Yang, Zhang Yu
Department of Neurosurgery, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China.
Center for Evidence-based Medicine, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China.
Ann Intensive Care. 2024 Nov 28;14(1):177. doi: 10.1186/s13613-024-01411-1.
The effects of restrictive versus liberal transfusion strategies in critically ill patients with traumatic brain injury (TBI) and anemia, particularly in adult patients with moderate to severe TBI, remain inconclusive. Therefore, this systematic review and meta-analysis aim to evaluate the comparative impact of restrictive and liberal red blood cell transfusion strategies among critically ill adult patients with moderate to severe TBI.
We conducted a search of PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials from their inception through October 20, 2024, to identify randomized controlled trials that compared restrictive (transfusions at a hemoglobin level of ≤ 7 g/dL) and liberal (transfusions at a hemoglobin level of ≤ 9-10 g/dL) transfusion strategies in adult patients with TBI. The primary outcome was mortality, with secondary outcomes including an unfavorable neurological outcome at six months, as determined by the Glasgow Outcome Scale (GOS < 4; or Glasgow Outcome Scale-Extended [GOSE] < 6), and the number of units of packed red blood cells (pRBCs) transfused.
Five randomized controlled trials involving 1,528 patients were included in the analysis. The results showed that restrictive transfusion, compared to liberal transfusion, had no impact on mortality (RR 1.00, 95% CI 0.80 to 1.24, I = 0%) or unfavorable neurological outcome at 6 months (RR 1.06, 95% CI 0.94 to 1.20, I = 47%). Restrictive transfusion was associated with a reduction in the number of units of pRBCs transfused (MD -2.62, 95% CI -3.33 to -1.90, I = 63%).
In patients with TBI, a restrictive transfusion strategy did not reduce the risk of mortality or unfavorable neurological outcome compared with a liberal transfusion strategy.
对于创伤性脑损伤（TBI）合并贫血的重症患者，尤其是中度至重度TBI的成年患者，限制性输血策略与宽松输血策略的效果仍无定论。因此，本系统评价和荟萃分析旨在评估限制性和宽松红细胞输血策略对中度至重度TBI成年重症患者的比较影响。
我们检索了PubMed、EMBASE和Cochrane对照试验中心注册库，检索时间从建库至2024年10月20日，以确定比较限制性（血红蛋白水平≤7 g/dL时输血）和宽松（血红蛋白水平≤9 - 10 g/dL时输血）输血策略的成年TBI患者的随机对照试验。主要结局是死亡率，次要结局包括6个月时不良神经结局，由格拉斯哥预后量表（GOS < 4；或格拉斯哥扩展预后量表[GOSE] < 6）确定，以及输注的浓缩红细胞（pRBCs）单位数。
分析纳入了5项涉及1528例患者的随机对照试验。结果显示，与宽松输血相比，限制性输血对死亡率（RR 1.00，95%CI 0.80至1.24，I² = 0%）或6个月时的不良神经结局（RR 1.06，95%CI 0.94至1.20，I² = 47%）没有影响。限制性输血与输注的pRBCs单位数减少相关（MD -2.62，95%CI -3.33至-1.90，I² = 63%）。
在TBI患者中，与宽松输血策略相比，限制性输血策略并未降低死亡率或不良神经结局的风险。
