【罂粟摘要】心脏手术后的限制性输血策略
心脏手术后的限制性输血策略
翻译：易菁 编辑：佟睿 审校：曹莹
贵州医科大学 高鸿教授课题组
心脏手术中最新的输血指南表明，血红蛋白可能不是决定输血的唯一标准。中央静脉血氧饱和度（SvO2）与组织氧输送和消耗间平衡有关，可能有助于决定是否输血。我们设计了一项随机研究，以评价中央SvO2指导的输血是否可以减少心脏手术后的输血发生率。
本研究是在一所教学医院重症监护病房（ICU）的心脏手术后成年患者进行的单中心、单盲、随机对照试验。术前对患者进行筛查，如果他们在ICU住院期间出现贫血（血红蛋白低于9g/dl）且没有活动性出血，则随机分为两组（对照组或SvO2组）。在ICU停留期间，除SvO2组患者输血前中央SvO2小于或等于65％时才输血外，其余患者每次贫血发生时都要输血。主要观察指标是在ICU中输血的患者比例。次要观察指标中着重关注（1）在ICU和研究结束时输的红细胞单位数量（2）在研究结束时输血的患者比例。
在484例筛查患者中，纳入100例，随机分为两组，每组50例。对照组所有患者在ICU中共输注94个红细胞单位。在SvO2组中，有34个（68％）患者输血（比值比，0.031 [95％CI，0-0.153]；与对照组相比，P <0.001），共输注65个红细胞单位。在研究结束时，SvO2组的8例患者仍未输血，SvO2组的单位红细胞计数为96，对照组为126。
根据中央SvO2调整的限制性输注策略可能会显着降低输血发生率。
原始文献来源：
Anesthesiology.2021 Jan 21.pii: 115083.doi: 10.1097/ALN.0000000000003682
Restrictive Transfusion Strategy after Cardiac Surgery
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.