Carson J L, Duff A, Poses R M, Berlin J A, Spence R K, Trout R, Noveck H, Strom B L
Department of Medicine, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick 08903-0019, USA.
Lancet. 1996 Oct 19;348(9034):1055-60. doi: 10.1016/S0140-6736(96)04330-9.
Guidelines have been offered on haemoglobin thresholds for blood transfusion in surgical patients. However, good evidence is lacking on the haemoglobin concentrations at which the risk of death or serious morbidity begins to rise and at which transfusion is indicated.
A retrospective cohort study was performed in 1958 patients, 18 years and older, who underwent surgery and declined blood transfusion for religious reasons. The primary outcome was 30-day mortality and the secondary outcome was 30-day mortality or in-hospital 30-day morbidity. Cardiovascular disease was defined as a history of angina, myocardial infarction, congestive heart failure, or peripheral vascular disease.
The 30-day mortality was 3.2% (95% CI 2.4-4.0). The mortality was 1.3% (0.8-2.0) in patients with preoperative haemoglobin 12 g/dL or greater and 33.3% (18.6-51.0) in patients with preoperative haemoglobin less than 6 g/dL. The increase in risk of death associated with low preoperative haemoglobin was more pronounced in patients with cardiovascular disease than in patients without (interaction p < 0.03). The effect of blood loss on mortality was larger in patients with low preoperative haemoglobin than in those with a higher preoperative haemoglobin (interaction p < 0.001). The results were similar in analyses of postoperative haemoglobin and 30-day mortality or in-hospital morbidity.
A low preoperative haemoglobin or a substantial operative blood loss increases the risk of death or serious morbidity more in patients with cardiovascular disease than in those without. Decisions about transfusion should take account of cardiovascular status and operative blood loss as well as the haemoglobin concentration.
已发布关于外科手术患者输血血红蛋白阈值的指南。然而，对于死亡或严重并发症风险开始上升以及需要输血时的血红蛋白浓度，缺乏充分证据。
对1958例18岁及以上因宗教原因拒绝输血而接受手术的患者进行了一项回顾性队列研究。主要结局是30天死亡率，次要结局是30天死亡率或住院30天内的并发症。心血管疾病定义为有心绞痛、心肌梗死、充血性心力衰竭或外周血管疾病史。
30天死亡率为3.2%（95%CI 2.4 - 4.0）。术前血红蛋白12 g/dL或更高的患者死亡率为1.3%（0.8 - 2.0），术前血红蛋白低于6 g/dL的患者死亡率为33.3%（18.6 - 51.0）。与术前血红蛋白水平低相关的死亡风险增加在有心血管疾病的患者中比在无心血管疾病的患者中更明显（交互作用p < 0.03）。术前血红蛋白水平低的患者失血对死亡率的影响大于术前血红蛋白水平高的患者（交互作用p < 0.001）。对术后血红蛋白及30天死亡率或住院并发症的分析结果相似。
术前血红蛋白水平低或术中大量失血使有心血管疾病的患者比无心血管疾病的患者死亡或发生严重并发症的风险增加更多。关于输血的决策应考虑心血管状况、术中失血以及血红蛋白浓度。
