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大量输血的定义在成年人严重出血:一个系统的审查
Victor S Lin1, Emily Sun2, Serine Yau3
1Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Critical care (London, England)
|July 5, 2023
概括
大规模输血的定义在研究中差异很大,使实践评估复杂化. 这次审查发现了试验中的15个不同的定义,突出了关于红细胞体积和其他产品的共识的需要.
科学领域:
- 紧急医疗 紧急医疗
- 血液学 血液学 血液学
- 关键的护理关键的护理
背景情况:
- 大规模输血 (MT) 的定义缺乏跨研究的标准化.
- 这种变异性阻碍了研究解释和临床实践评估.
- 需要进行系统审查,以确定随机对照试验 (RCT) 中现有的MT定义.
研究的目的:
- 系统地识别和分析RCT中使用的所有MT定义.
- 为制定基于共识的MT定义提供信息.
- 在临床研究中解决MT标准的异质性.
主要方法:
- 系统地搜索多个数据库 (MEDLINE,Embase,CENTRAL,PubMed,CINAHL,TEL) 的RCT,直到2022年8月.
- 纳入标准:涉及有重大出血的成年患者接受或预期接受MT的RCT,指定MT定义.
- 搜索了正在进行的试验数据库 (CENTRAL,ClinicalTrials.gov,WHO ICTRP).
主要成果:
- 30个RCT (19个已发表,11个正在进行) 符合纳入标准.
- 确定了15个不同的MT定义,在红细胞 (RBC) 容量和时间参数上有所不同.
- 已发表的试验通常使用≥10个RBC单位/24小时 (创伤),而正在进行的试验使用3-5个RBC单位,通常时间定义不佳. 没有定义包括血或血小板.
结论:
- 已发表的RCT主要将MT定义为≥10个RBC单位/24h,而正在进行的试验使用较低的体积.
- 达成共识的定义必须纳入各种血液成分,并考虑设置特定的方法.
- 标准化MT定义对于推进输血医学研究和实践至关重要.
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