限制性或自由的输血策略在心肌梗塞和贫血
Jeffrey L Carson1, Maria Mori Brooks1, Paul C Hébert1
1From the Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (J.L.C., W.J.K., H.N., S.K.); the Departments of Epidemiology and Biostatistics, School of Public Health, University of Pittsburgh (M.M.B., M.B., S.F.K.), and the Department of Pathology, Division of Transfusion Medicine, University of Pittsburgh School of Medicine (D.J.T.) - both in Pittsburgh; the Bruyere Research Institute, University of Ottawa (P.C.H.), and the Clinical Epidemiology Program, Ottawa Hospital Research Institute (D.A.F.), Ottawa, St. Michael's Hospital, University of Toronto, Toronto (S.G.G.), Canadian VIGOUR Centre, University of Alberta (S.G.G.), and the Department of Medicine, Grey Nuns Hospital (M.S.), Edmonton, CHUM Research Centre (B.J.P.), the Departments of Anesthesiology and Medicine, Division of Critical Care, Centre Hospitalier de l'Université de Montréal, Innovation and Evaluation Hub, Centre de Recherche du CHUM (F.M.C., P.C.H.), and the Department of Anesthesiology and Pain Medicine, Université de Montréal (F.M.C.), Montreal, the Department of Medicine, McMaster University, Hamilton, ON (J.D.N.), the Division of Cardiology and Centre for Cardiovascular Innovation, Vancouver General Hospital and University of British Columbia, Vancouver (C.B.F.), and Centre Hospitalier Universitaire (CHU) de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC (B.D.) - all in Canada; the National Heart, Lung, and Blood Institute, Bethesda, MD (S.A.G.); St. Louis University School of Medicine, St. Louis (B.R.C.); FACT (French Alliance for Cardiovascular Trials) (T.S., G.D., P.G.S.), Service de Pharmacologie, Plateforme de Recherche Clinique de l'Est Parisien, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint Antoine, Sorbonne Université (T.S.), Université Paris-Cité, INSERM Unité 1148 and AP-HP, Hôpital Bichat (G.D., P.G.S.), Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière AP-HP (J.S.), and AP-HP, Hôpital Européen Georges Pompidou, Department of Cardiology, Université de Paris (E.P.), Paris, Hôpital Pasteur, Service de Cardiologie, CHU Nice, Nice (E.F.), University Hospital of Poitiers, Clinical Investigation Center (INSERM 1204), Cardiology Department, Poitiers (C.B.), and Nimes University Hospital, Montpelier University, ACTION Group, Nimes (B.L.) - all in France; Duke Clinical Research Institute, Duke University, Durham (R.D.L., J.H.A.), and the Department of Medicine, WakeMed Health and Hospitals, Winston-Salem (F.O.W.) - both in North Carolina; Brazilian Clinical Research Institute, Sao Paulo (R.D.L., P.G.M.B.S.); the Department of Medicine, Baystate Medical Center, Springfield (A.M.G.), and the Department of Pathology (L.U.) and Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology (J.B.S.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston - both in Massachusetts; the University of Nebraska Medical Center, Omaha (A.M.G.); the Department of Medicine, Vanderbilt University Medical Center, Nashville (A.P.D.); Lifespan Cardiovascular Institute and the Department of Medicine, Division of Cardiology, Alpert Medical School of Brown University, Providence, RI (J.D.A.); the Department of Medicine, NYU Langone Health System (S.V.R.), and the Department of Medicine, Montefiore Medical Center (M.A.M.), New York, and the Department of Cardiology, Westchester Medical Center, Valhalla (H.A.C.) - all in New York; the Department of Medicine, University of Louisville, Louiville, KY (S.G.); UChicago AdventHealth Heart and Vascular (M.T.) and the Department of Medicine, University of Chicago Medicine (T.S.P.) - both in Chicago; and Green Lane Coordinating Center, Auckland, New Zealand (C.A., H.D.W.).
自由的红细胞输血策略并没有显著减少贫血患者的心肌梗塞或死亡. 然而,限制性输血策略可能会带来潜在的危害,在临床实践中需要仔细考虑.
科学领域:
- 心脏病学 心脏病学
- 血液学 血液学 血液学
- 临界护理医学 临界护理医学
背景情况:
- 针对贫血的红细胞输血的标准实践通常是在血红蛋白水平下降到7-8g/dL时开始的.
- 患有急性心肌梗塞 (AMI) 的患者可能会从更高的血红蛋白水平中受益.
- 在AMI患者中输血的最佳血红蛋白值仍然是临床研究的领域.
研究的目的:
- 在急性心肌梗塞和贫血患者中,比较限制性与自由性的红细胞输血策略的疗效和安全性.
- 确定输血值对复发性心肌梗塞或在事件发生后30天内死亡的发生率的影响.
主要方法:
- 一项第三期随机干预试验,涉及3504名心肌梗塞和血红蛋白<10g/dL的患者.
- 患者被分配到限制性输血策略 (血红蛋白切断值7-8 g/dL) 或自由的输血策略 (血红蛋白切断值<10 g/dL).
- 主要终点是30天内心肌梗塞或全因死亡率的复合结果.
主要成果:
- 自由输血策略组与限制性组 (0.7±1.6) 相比,接受红细胞单位 (2.5±2.3) 的显著增加.
- 两组之间主要结局事件发生率没有统计学上显著的差异 (16.9%的限制性与14.5%的自由性;风险比率1.15,95%CI 0.99-1.34).
- 主要结局的各个组成部分,包括死亡和心肌梗塞,在两种策略之间也没有显著差异.
结论:
- 在AMI和贫血患者中,自由的输血策略并没有显著降低30天内心肌梗塞复发或死亡的风险.
- 这项研究表明,虽然自由的方法可能不会带来显著的好处,但不能排除与限制性策略相关的潜在危害.
- 可能需要进一步的研究来确定精确的输血门,以优化这一患者群体的结果.
相关概念视频
Blood Transfusion
Blood Transfusion Overview
A blood transfusion is a medical procedure used to replace blood lost due to injury, surgery, or to treat conditions such as anemia or cancer. During a transfusion, donor blood is...
Cardiomyopathy IV: Restrictive Cardiomyopathy
Blood Transfusion and Agglutination
History
The history of blood transfusion dates back to the 17th century, when early attempts were made in animals. In 1818 James Blundell, a British doctor, performed the first successful human blood transfusion. Later in 1900, Karl...
Myocarditis I: Introduction


