红细胞输血后与医疗保健相关的感染:系统性审查和元分析
Jeffrey M Rohde1, Derek E Dimcheff1, Neil Blumberg2
1University of Michigan, Division of General Medicine, Department of Internal Medicine, Ann Arbor.
JAMA
|April 3, 2014
概括
与自由的方法相比,限制性红细胞 (RBC) 输血策略显著降低了住院患者严重感染的风险. 这一发现表明,限制性策略可以降低医疗保健相关感染率.
科学领域:
- 输血医学 输血医学
- 传染病流行病学 传染病流行病学
- 临床试验分析
背景情况:
- 红细胞 (RBC) 输血实践与医疗相关感染 (HAI) 之间的关系需要进一步澄清.
- 了解输血值和白细胞减少对感染风险的影响对于患者安全至关重要.
研究的目的:
- 研究限制性与自由的红细胞输血策略与发展HAI的风险之间的关联.
- 要确定这种关联是否独立于白细胞减少的红细胞.
主要方法:
- 随机临床试验的系统审查和元分析,比较限制性和自由的红细胞输血策略.
- 在多个数据库 (MEDLINE,EMBASE等) 进行了搜索. 对于相关的试验,截至2014年1月.
- 使用随机效应模型计算了聚合风险比率和绝对感染风险.
主要成果:
- 限制性红细胞输血策略与严重感染的风险明显降低相关 (风险比率[RR]=0.82;95% CI,0.72-0.95).
- 用限制性策略治疗 (NNT) 预防一个严重感染的必要人数为38.
- 限制性策略的感染风险降低,即使在白细胞减少的血液制品中也被观察到,在骨科手术患者和败血症患者中尤其明显.
结论:
- 限制性红细胞输血策略与住院患者中HAI发病率降低有关.
- 实施严格的输血协议可能是一个有效的方法来降低HAI率.
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