貧血と重症患者の輸血
Jean Louis Vincent1, Jean-François Baron, Konrad Reinhart
1Department of Intensive Care, Erasme University Hospital, Route de Lennik 808, Brussels, 1070, Belgium. jlvincen@ulb.ac.be
JAMA
|September 24, 2002
まとめ
貧血は集中治療室 (ICU) で一般的であり,多くの患者は赤血球 (RBC) 輸血を受けています. この研究では,輸血が重症患者の臓器機能不全と死亡率の増加と関連していることが判明しました.
科学分野:
- クリティカルケア・メディシン
- 血液学 ヘマトロジ
- エピデミオロジー エピデミオロジー
背景:
- 貧血は,重症病棟 (ICU) に入院している重症患者の間で一般的です.
- この患者集団における罹病率と死亡率に対する貧血の影響は十分に理解されていません.
- 集中治療室での頻繁な採血は,貧血を助長する.
研究 の 目的:
- 貧血の発生率と重症患者の赤血球 (RBC) 輸血率を決定する.
- ICUの環境における赤血球輸血の潜在的利益とリスクを調査する.
- 貧血,輸血,患者の結果との関連性を調査する.
主な方法:
- 血液採取研究と貧血と輸血研究という2つの構成要素を含む見通しの観察研究です.
- 西ヨーロッパICUの145-146から収集されたデータで,1100人以上の患者 (血液採取) と3500人の患者 (貧血/輸血) が含まれています.
- 測定された主なアウトカムには,採血量,ヘモグロビンレベル,輸血率,臓器機能不全 (連続臓器不全評価スコア),28日間の死亡率または退院率が含まれています.
主要な成果:
- 患者1人当たりの平均血液の量は,臓器機能不全と正の相関関係があり,有意であった.
- ICUの患者の約30%は入院時に10g/dL未満のヘモグロビン濃度でした.
- 相当な輸血率 (37%) が観察され,高齢の患者およびICU滞在時間が長い患者ではより高い割合を示した.
- 輸血を受けた患者は,輸血を受けていない患者と比較して,ICUと全体的な死亡率が大幅に上昇しました.
- 臓器機能不全の重さに調整しても,輸血を受けた患者は死亡率が増加した.
結論:
- 貧血は重症患者の頻繁な状態であり,大量に赤血球 (RBC) 輸血を使用することにつながります.
- この研究は,赤血球輸血が臓器機能の低下と死亡率の増加を含む,より悪い結果と関連している疫学的な証拠を提供します.
- この発見は,集中治療施設における輸血慣行の再評価の必要性を示唆している.
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