Rubens F D, Fergusson D, Wells P S, Huang M, McGowan J L, Laupacis A
Department of Surgery, University of Ottawa Heart Institute, Ontario, Canada.
J Thorac Cardiovasc Surg. 1998 Oct;116(4):641-7. doi: 10.1016/s0022-5223(98)70172-2.
Our purpose was to determine whether intraoperative platelet-rich plasmapheresis in cardiac surgery is effective in reducing the proportion of patients exposed to allogeneic red cell transfusions.
A systematic search for prospective, randomized trials of platelet-rich plasmapheresis in cardiac surgery, using MEDLINE, HEALTHSTAR, Current Contents, "Biological Abstracts," and EMBASE/Excerpta Medica up to August 1997, was completed. Trials were included if they reported either the proportion of patients exposed to allogeneic red cells or the units of allogeneic red cells transfused. Trials were abstracted by 2 independent investigators and the quality of trial design was assessed with the use of a validated scale.
Seventeen references met the inclusion criteria (1369 patients [675 control: 694 platelet-rich plasmapheresis]). Platelet-rich plasmapheresis reduced the likelihood of exposure to allogeneic red cells in cardiac surgery (odds ratio 0.44; 95% confidence interval 0.27, 0.72, P = .001). Platelet-rich plasmapheresis had a small but statistically significant effect on both the volume of blood lost in the first 24 hours (weighted mean difference -102 mL; 95% confidence interval -148, -55 mL, P < .0001) and the mean units transfused (weighted mean difference -0.33 units; 95% confidence interval -0.43, -0.23, P < .0001). However, platelet-rich plasmapheresis was only marginally effective (odds ratio 0.83, 95% confidence interval 0.34, 2.01, P = .68) for "good" quality trials, whereas it appeared very effective in trials with poor methodologic quality (odds ratio 0.33, 95% confidence interval 0.17, 0.62, P = .0007).
Although platelet-rich plasmapheresis appeared effective in decreasing the proportion of patients receiving transfusions after cardiac operations, the quality of most of the supporting trials was low and the benefit was small in trials of good quality. Further clinical trials should be completed.
我们的目的是确定心脏手术中术中富血小板血浆置换术是否能有效降低接受异体红细胞输血的患者比例。
利用MEDLINE、HEALTHSTAR、《现刊目次》、《生物学文摘》和截至1997年8月的EMBASE/医学文摘数据库，系统检索心脏手术中富血小板血浆置换术的前瞻性随机试验。如果试验报告了接受异体红细胞的患者比例或输注的异体红细胞单位数，则纳入该试验。由2名独立研究人员提取试验数据，并使用经过验证的量表评估试验设计的质量。
17篇参考文献符合纳入标准（1369例患者[675例对照：694例富血小板血浆置换术]）。富血小板血浆置换术降低了心脏手术中接触异体红细胞的可能性（优势比0.44；95%置信区间0.27，0.72，P = 0.001）。富血小板血浆置换术对术后24小时内失血量（加权平均差-102 mL；95%置信区间-148，-55 mL，P < 0.0001）和平均输注单位数（加权平均差-0.33单位；95%置信区间-0.43，-0.23，P < 0.0001）均有小但具有统计学意义的影响。然而，富血小板血浆置换术在“高质量”试验中仅具有微弱的效果（优势比0.83，95%置信区间0.34，2.01，P = 0.68），而在方法学质量较差的试验中似乎非常有效（优势比0.33，95%置信区间0.17，0.62，P = 0.0007）。
尽管富血小板血浆置换术似乎能有效降低心脏手术后接受输血的患者比例，但大多数支持性试验的质量较低，且在高质量试验中获益较小。应完成进一步的临床试验。
