Bellantone R, Sitges-Serra A, Bossola M, Doglietto G B, Malerba M, Franch G, Pacelli F, Crucitti F
Istituto di Clinica Chirurgica, Università Cattolica del Sacro Cuore, Roma, Italy.
Arch Surg. 1998 Sep;133(9):988-92. doi: 10.1001/archsurg.133.9.988.
Immunosuppression associated with homologous blood transfusion was first observed in renal allograft transplantation. Clinical effects of transfusion-induced immunosuppression in surgical patients have been debated in the literature for more than a decade with contradictory results.
To investigate whether homologous blood transfusions significantly affect postoperative septic morbidity and mortality in patients undergoing elective surgery for gastric cancer.
Case series.
Hospitalized care.
The hospital records of 209 patients who underwent elective surgery for gastric cancer at the Department of Surgery of the Hospital del Mar, Autonomous University of Barcelona in Spain, and at the Department of Surgery of the Catholic University of Rome in Italy from April 1984 to December 1990 were reviewed, and 179 patients were included in the study.
The following variables were entered into univariate and multivariate analyses to identify factors potentially affecting postoperative septic morbidity: demographic data, weight loss, preoperative serum albumin level and lymphocyte count, type and duration of operative procedure, amount and timing of blood transfusion, and stage of disease.
Univariate analysis showed that a large quantity of blood transfused (> 1500 mL) and transfusion in the postoperative period (group C) were associated with a worse clinical outcome. Postoperative transfusion was an independent predictor of septic morbidity in multivariate analysis.
Despite transfusion-induced immunomodulation, homologous blood transfusion should not be considered a risk factor for postoperative septic morbidity in patients undergoing elective major abdominal surgery. The timing-response relationship between transfusions and septic morbidity in multivariate analysis may be the effect of uncontrolled confounders such as variation of volemia induced by stress response in patients who were developing or had just developed infectious complications.
与同种异体输血相关的免疫抑制最早在肾移植中被观察到。输血诱导的免疫抑制对手术患者的临床影响在文献中已争论了十多年，结果相互矛盾。
探讨同种异体输血是否会显著影响择期胃癌手术患者术后的感染发病率和死亡率。
病例系列研究。
住院治疗。
回顾了1984年4月至1990年12月在西班牙巴塞罗那自治大学德尔马医院外科和意大利罗马天主教大学外科接受择期胃癌手术的209例患者的医院记录，179例患者纳入研究。
将以下变量纳入单因素和多因素分析，以确定可能影响术后感染发病率的因素：人口统计学数据、体重减轻、术前血清白蛋白水平和淋巴细胞计数、手术类型和持续时间、输血量和输血时间以及疾病分期。
单因素分析显示，大量输血（>1500 mL）和术后输血（C组）与较差的临床结局相关。在多因素分析中，术后输血是感染发病率的独立预测因素。
尽管输血可诱导免疫调节，但对于接受择期腹部大手术的患者，不应将同种异体输血视为术后感染发病率的危险因素。多因素分析中输血与感染发病率之间的时间反应关系可能是由未控制的混杂因素所致，如正在发生或刚发生感染并发症的患者因应激反应引起的血容量变化。
