患者血液管理:2018年法兰克福共识会议的建议
Markus M Mueller1, Hans Van Remoortel2, Patrick Meybohm3
1German Red Cross Blood Transfusion Service and Goethe University Clinics, Frankfurt/Main, Germany.
JAMA
|March 13, 2019
概括
在重症和心脏手术患者中,患者血液管理 (PBM) 建议在手术前早期治疗贫血,并为红细胞 (RBC) 输血设定特定的血红蛋白值. 为适当使用红细胞,建议使用全面的PBM程序.
科学领域:
- 基于证据的医学
- 血液学
- 危急护理医学
背景情况:
- 输血是一种常见的治疗方法,
- 患者血液管理 (PBM) 旨在优化结果并减少输血相关的并发症.
- 制定基于证据的建议对于指导PBM的临床实践和未来研究至关重要.
研究的目的:
- 为患者血液管理 (PBM) 制定基于证据的建议.
- 为成人患者确定最佳的红细胞输血值.
- 为了指导未来的输血医学和PBM研究.
主要方法:
- 在三个关键领域制定了17个人口/干预/比较/结果 (PICO) 问题:手术前贫血,红细胞输血门和PBM计划实施.
- 在四个主要的生物医学数据库中进行了全面的文献搜索,分析了从创建到2018年1月的数据.
- 分析利用了GRADE方法论和证据到决策框架,在共识会议中涉及多学科小组.
主要成果:
- 根据对145项研究的分析 (63项RCT,82项观察性研究) 提出了建议.
- 强烈建议包括早期检测和治疗手术前的贫血和特定的红细胞输血值 (血红蛋白 < 7 g/ dL 严重患者, < 7. 5 g/ dL 心脏手术).
- 有条件的建议支持全面的PBM计划的实施和电子决策支持系统的使用.
结论:
- 2018年PBM国际共识会议制定了10项临床和12项研究建议.
- 这些发现突显出需要进一步研究,因为在几个领域相对缺乏确的证据.
- 对定义,血红蛋白值和有意义的终点的国际共识对于未来的多中心试验至关重要.
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