Tartter P I, Mohandas K, Azar P, Endres J, Kaplan J, Spivack M
Department of Surgery, Mount Sinai Medical Center, New York, New York 10029, USA.
Am J Surg. 1998 Nov;176(5):462-6. doi: 10.1016/s0002-9610(98)00245-1.
Allogeneic transfusion is associated with postoperative infections that significantly prolong hospital stays and increase costs. Recent studies suggest that filtering leukocytes from blood prior to transfusion reduces the risk of postoperative infection associated with blood transfusion. We compared the incidence of postoperative infections, hospital stays, and hospital charges of gastrointestinal surgery patients transfused with packed red cells or leukocyte-depleted cells.
Consecutive patients admitted for elective gastrointestinal surgery without previous blood transfusion were randomized to receive routine packed red cells or packed red cells filtered to remove leukocytes if transfusion was required. Multivariate analysis was used to assess the significance of the relationship between leukocyte-depleted blood and postoperative infectious complications, postoperative stay, and hospital charges.
Fifty-nine (27%) of the 221 patients were transfused. The most significant variable related to transfusion was intraoperative blood loss (P <0.0001), followed by admission hematocrit (P <0.0001) and age (P = 0.0022). Infections were noted in 16% of the patients: 11% of untransfused patients, 16% of leukocyte-depleted blood recipients, and 44% of patients transfused with packed red cells. Both operative site and nosocomial infections were significantly (P <0.001) more frequent in patients transfused with packed red cells compared with patients transfused with leukocyte-depleted red cells. Postoperative stays averaged 9 days for untransfused patients, 12 days for leukocyte-depleted recipients, and 18 days for recipients of packed red cells. Hospital charges were $19,132, $33,954, and $41,002, respectively. Both transfusion and infection were significantly (P <0.001) related to postoperative stay in multivariate analysis. Hospital charges were significantly related to postoperative stay (P <0.001), blood loss (P <0.001), age (P <0.001), infection (P = 0.007), and randomization to packed red cells (P = 0.032).
Filtering blood of leukocytes prior to transfusion for elective gastrointestinal surgery is associated with lower risk of postoperative infection, shorter postoperative stays, and lower hospital charges.
异体输血与术后感染相关，这会显著延长住院时间并增加费用。近期研究表明，输血前过滤血液中的白细胞可降低与输血相关的术后感染风险。我们比较了接受浓缩红细胞或去白细胞红细胞输血的胃肠外科手术患者的术后感染发生率、住院时间和住院费用。
将连续收治的择期胃肠外科手术患者（既往未输血）随机分为两组，若需要输血，一组接受常规浓缩红细胞，另一组接受过滤去除白细胞的浓缩红细胞。采用多因素分析评估去白细胞血液与术后感染并发症、术后住院时间和住院费用之间关系的显著性。
221例患者中有59例（27%）接受了输血。与输血最相关的变量是术中失血（P<0.0001），其次是入院时的血细胞比容（P<0.0001）和年龄（P = 0.0022）。16%的患者发生了感染：未输血患者为11%，接受去白细胞血液的患者为16%，接受浓缩红细胞输血的患者为44%。与接受去白细胞红细胞输血的患者相比，接受浓缩红细胞输血的患者手术部位感染和医院获得性感染均显著更频繁（P<0.001）。未输血患者术后平均住院9天，接受去白细胞血液的患者为12天，接受浓缩红细胞输血的患者为18天。住院费用分别为19,132美元、33,954美元和41,002美元。在多因素分析中，输血和感染均与术后住院时间显著相关（P<0.001）。住院费用与术后住院时间（P<0.001）、失血（P<0.001）、年龄（P<0.001）、感染（P = 0.007）以及随机分组至接受浓缩红细胞输血组（P = 0.032）显著相关。
择期胃肠外科手术输血前过滤血液中的白细胞与较低的术后感染风险、较短的术后住院时间和较低的住院费用相关。
