细胞救援用于最大限度地减少接受选择性手术的成年人周围手术时的全基性输血
Thomas D Lloyd1, Louise J Geneen2,3, Keeley Bernhardt4
1Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
The Cochrane database of systematic reviews
|September 8, 2023
概括
细胞救援 (CS) 在某些选择性手术中可能会减少全基输血,但对其他手术的证据尚不确定. 需要更多的研究来了解它在不同类型的手术和患者群体中的有效性.
科学领域:
- 输血医学 输血医学
- 外科手术的安全性
- 基于证据的医学基于证据的医学.
背景情况:
- 越来越多的人担心捐献血液的安全性和可用性,因此需要制定策略,尽量减少全基因输血.
- 细胞救援 (CS) 是一种从手术场所回收血液以重新输入患者的技术.
研究的目的:
- 为了评估细胞救援 (CS) 在减少外科手术期间红细胞输血中的有效性.
- 评估CS对接受选择性或非紧急手术的成年患者其他临床结果的影响.
主要方法:
- 进行了对多个数据库和临床试验注册表进行随机对照试验 (RCT) 和系统审查的系统搜索.
- 包括RCT比较CS与没有CS在接受选择性手术的成年患者.
- 分析了106项涉及14528名参与者的RCT的数据,结果按手术类型分层.
主要成果:
- 总的来说,证据表明CS可以减少异构输血的确定性非常低.
- 中等确定性证据表明,CS可能会减少心血管 (没有旁路) 和骨科 (脊柱) 手术中的输血.
- 对CS有效性和对不良事件的影响的证据在不同外科专业之间有很大差异,许多领域的不确定性很高.
结论:
- 细胞救援可能会减少在特定类型的选择性手术中对异构输血的需求和体积.
- 在不同类型的手术中,对益处的证据是不一致的,需要进一步分析和在研究不足的领域进行大型RCT.
- 需要进一步的研究来澄清CS的作用,并确定它提供明显优势的特定外科背景.
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