外科肿瘤病人的输血需求---一项前瞻性的随机对照研究

pingchi1983

Transfusion Requirements in Surgical Oncology Patients---A Prospective, Randomized Controlled Trial
ABSTRACT
Background: Several studies have indicated that a restrictive erythrocyte transfusion strategy is as safe as a liberal one in critically ill
patients, but there is no clear evidence to support the superiority of any perioperative transfusion strategy in patients with cancer.
Methods: In a randomized, controlled, parallel-group, double-blind (patients and outcome assessors) superiority trial in the intensive
care unit of a tertiary oncology hospital, the authors evaluated whether a restrictive strategy of erythrocyte transfusion (transfusion
when hemoglobin concentration <7 g/dl) was superior to a liberal one (transfusion when hemoglobin concentration <9 g/dl) for
reducing mortality and severe clinical complications among patients having major cancer surgery. All adult patients with cancer having
major abdominal surgery who required postoperative intensive care were included and randomly allocated to treatment with the
liberal or the restrictive erythrocyte transfusion strategy. The primary outcome was a composite endpoint of mortality and morbidity.
Results: A total of 198 patients were included as follows: 101 in the restrictive group and 97 in the liberal group. The primary composite
endpoint occurred in 19.6% (95% CI, 12.9 to 28.6%) of patients in the liberal-strategy group and in 35.6% (27.0 to 45.4%) of patients
in the restrictive-strategy group (P = 0.012). Compared with the restrictive strategy, the liberal transfusion strategy was associated with an
absolute risk reduction for the composite outcome of 16% (3.8 to 28.2%) and a number needed to treat of 6.2 (3.5 to 26.5).
Conclusion: A liberal erythrocyte transfusion strategy with a hemoglobin trigger of 9 g/dl was associated with fewer major
postoperative complications in patients having major cancer surgery compared with a restrictive strategy. (Anesthesiology
2015; 122:29-38)

摘要
背景：许多研究表明对危重病人采取限制性输注红细胞与开放性输注红细胞两种策略一样安全，然而对于肿瘤病人围术期输血哪一种方案更有优势尚没有明显证据。
方法：在一家三级肿瘤医院的ICU采用随机双盲对照的方法来评估限制性输血（仅在血色素<7 g/dl才输血）和开放性输血（仅在血色素<9 g/dl才输血）两种策略对于降低接受大手术的肿瘤病人术后死亡率和临床并发症的影响。所有接受腹部大手术的肿瘤病人都被列入并随机分配到两个组，主要的指标是死亡率和病残率的复合临床终点
结果：198名患者参与调查，101名限制性输血组，其复合终点高达35.6%，97名开放性输血，其复合终点为19.6%，显著低于限制性组(P = 0.012)，开放性输血能降低术后不良结局的临床风险，也减少相应的救治人数。
结论： 在血色素<9 g/dl即开始输血的开放性策略术后并发症小于血色素<7 g/dl才输血的限制性输血策略