肝移植中的前列红素复合度的有效性和安全性:来自观察研究的证据
Giovanni Punzo1, Valeria Di Franco1, Valter Perilli1,2
1Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy.
Journal of clinical medicine
|June 10, 2023
概括
输血组复合物缩剂 (PCC) 在肝移植 (LT) 患者中没有显著减少血液产品输血. 然而,四因子PCC显示了红细胞输血的潜在减少,需要进一步调查.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 输血医学 输血医学
- 关键护理医学 关键护理医学
背景情况:
- 对于治疗末期肝病患者的凝血缺陷,特别是肝移植 (LT) 期间,前热血素复合物缩剂 (PCC) 的疗效仍然不确定.
- 评估PCC的风险/益处比对于优化复杂外科手术过程中的患者护理至关重要.
研究的目的:
- 系统地审查和元分析PCCs的临床有效性,以尽量减少在接受LT患者的血液产品输血需求.
- 评估PCC对二次结果的影响,包括血栓事件,功能和资源利用.
主要方法:
- 根据PRISMA指南,对非随机临床试验进行了系统审查,该协议在PROSPERO.上注册.
- 分析包括来自4项涉及638名患者的研究的数据,重点是输血红细胞单位,新鲜冷血,血小板和冷沉积物.
- 敏感性分析专门研究了四因素PCC的影响,以及动脉血栓形成和急性损伤等二次结果.
主要成果:
- 总体而言,PCC的使用没有显示在LT期间输血血制品的显著减少.
- 专注于四因子PCC的敏感性分析显示,红细胞输血的统计显著减少 (效果大小:2.06;95% CI:1.27-2.84),没有显著的异质性.
- 在二次结局方面没有发现显著差异,例如动脉血栓形成,急性损伤或住院/ICU停留时间.
结论:
- 目前的证据表明,PCCs在减少LT人群输血血液产品时可能没有广泛的效果.
- 需要进行进一步的有针对性的研究,以确定在精选的LT患者中四因素PCC治疗的具体益处.
- 未来的研究应侧重于确定最有可能从四因素PCC中受益的患者子组.
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