在心脏手术前对贫血患者实施短期治疗方案
Dror B Leviner1, Dana Abraham2, Maayan Shiner3
1Department of Cardiothoracic Surgery, Carmel Medical Center, Haifa, Israel.
The Thoracic and cardiovascular surgeon
|September 14, 2023
概括
对贫血患者实施手术前治疗显著减少了手术前红细胞输血 (PRBC) 和改善了血红蛋白水平,证明了其在现实环境中的有效性.
科学领域:
- 麻醉学 麻醉学
- 血液学 血液学 血液学
- 手术护理 手术护理
背景情况:
- 贫血是手术患者常见的并发症,增加了术后并发症的风险和需要输血的需要.
- 在手术前优化血红蛋白水平对于改善患者的治疗结果和减少输血需求至关重要.
- 需要现实世界的数据来评估手术前贫血治疗方案的有效性.
研究的目的:
- 评估即时手术前治疗方案对贫血患者手术前红细胞输血 (PRBC) 的影响.
- 在现实世界临床环境中评估该协议对患者结果的影响.
- 确定该协议是否会导致PRBC输血发生率和整体血液产品使用率的减少.
主要方法:
- 对贫血患者 (Hb <11.5 g/dL女性, <12.5 g/dL男性) 实施了一项涉及皮下红蛋白α,静脉注射铁和肌内维生素B12 (手术前),以及口服铁和叶酸 (手术后) 的外科手术协议.
- 在接受该方案的患者 (n=114) 和在前4年没有接受该方案 (n=236) 的符合条件的贫血患者之间进行了回顾性比较.
- 测量的主要结果是手术期间的PRBC输血量和医院入院指数.
主要成果:
- 治疗方案显著降低了PRBC总使用量 (中位数为2个单位与4个单位,p < 0.0001).
- 与对照组相比,治疗组中术后输血产品的发生率较低 (50.88%) (75%,p < 0.0001).
- 在出院前的血红蛋白水平在协议组 (中位数9 g/dL) 与对照组 (中位数8.6 g/dL,p = 0.0081) 相比显著更高.
结论:
- 对贫血患者实施术后治疗方案与PRBC输血的显著减少有关.
- 该协议在现实环境中表现出有效性,导致血液产品使用量减少.
- 这种方法为手术患者的贫血管理和改善输血结果提供了可行的策略.
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