【罂粟摘要】心脏手术后限制性输血策略——中心静脉血氧饱和度的指导作用：一项随机对照试验
中文摘要
心脏手术后限制性输血策略——中心静脉血氧饱和度的指导作用：一项随机对照试验
贵州医科大学 高鸿教授课题组
翻译：佟睿 编辑：佟睿 审校：曹莹
01
近年来关于心脏手术输血的指南表明，血红蛋白指标可能不是输血的唯一标准。中心静脉血氧饱和度(SvO2)与组织的氧供需平衡有关，有助于指导输血决策。我们设计了一项随机研究，以验证SvO2指导输血是否可以减少心脏手术后输血的发生率。
近年来关于心脏手术输血的指南表明，血红蛋白指标可能不是输血的唯一标准。中心静脉血氧饱和度(SvO2)与组织的氧供需平衡有关，有助于指导输血决策。我们设计了一项随机研究，以验证SvO2指导输血是否可以减少心脏手术后输血的发生率。
在484名筛查的患者中，选取100名患者被随机分为两组，每组50人。对照组均在ICU输血，共输入红细胞94个单位。在SvO2组中，34名患者(68%)接受了输血(与对照组相比优势比，0.031[95%CI，0~0.153]；P<0.001)，总共输入了65个红细胞单位。在出院时，SvO2组的8名患者仍未输血，SvO2组的累计红细胞单位计数为96个，对照组为126个。
根据中心静脉SvO2调整限制性输血策略可能会显著降低输血的发生率。
Restrictive Transfusion Strategy after Cardiac Surgery
Role of Central Venous Oxygen Saturation Trigger: A Randomized Controlled Trial
Abstract
Background: Recent guidelines on transfusion in cardiac surgery suggest that hemoglobin might not be the only criterion to trigger transfusion. Central venous oxygen saturation (SvO2), which is related to the balance between tissue oxygen delivery and consumption, may help the decision process of transfusion. We designed a randomized study to test whether central SvO2–guided transfusion could reduce transfusion incidence after cardiac surgery.
Methods: This single center, single-blinded, randomized controlled trial was conducted on adult patients after cardiac surgery in the intensive care unit (ICU) of a tertiary university hospital. Patients were screened preoperatively and were assigned randomly to two study groups (control or SvO2) if they developed anemia (hemoglobin less than 9 g/dl), without active bleeding, during their ICU stay. Patients were transfused at each anemia episode during their ICU stay except the SvO2 patients who were transfused only if the pretransfusion central SvO2 was less than or equal to 65%. The primary outcome was the proportion of patients transfused in the ICU. The main secondary endpoints were (1) number of erythrocyte units transfused in the ICU and at study discharge, and (2) the proportion of patients transfused at study discharge.
Results: Among 484 screened patients, 100 were randomized, with 50 in each group. All control patients were transfused in the ICU with a total of 94 transfused erythrocyte units. In the SvO2 group, 34 (68%) patients were transfused (odds ratio, 0.031 [95% CI, 0 to 0.153]; P < 0.001 vs. controls), with a total of 65 erythrocyte units. At study discharge, eight patients of the SvO2 group remained nontransfused and the cumulative count of erythrocyte units was 96 in the SvO2 group and 126 in the control group.
Conclusions: A restrictive transfusion strategy adjusted with central SvO2 may allow a significant reduction in the incidence of transfusion.