整形外伤和贫血:保守与自由的输血策略:一个前性随机研究
Brian H Mullis1, Leilani S Mullis1, Laurence B Kempton1
1Department of Orthopaedics, Indiana University School of Medicine, Indianapolis, IN; and.
Journal of orthopaedic trauma
|December 14, 2023
概括
对于肌肉骨损伤的创伤患者来说,保守的5.5g/dL的红细胞输血门是安全的. 这种方法可以降低感染率,而不会影响功能结果.
科学领域:
- 创伤外科手术是什么
- 血液学 血液学 血液学
- 关键护理医学 关键护理医学
背景情况:
- 在创伤患者中,确定红细胞输血的最佳血红蛋白值对于患者的治疗结果至关重要.
- 之前的研究表明门有所不同,但在特定患者群体 (如肌肉骨损伤患者) 中的证据正在演变.
研究的目的:
- 为了比较保守的包装红细胞 (PRBC) 输血血红蛋白 (Hgb) 门5.5g/dL的安全性和有效性,与7.0g/dL的自由门相比.
- 评估输血值对肌肉骨损伤无症状创伤患者手术后感染率和功能结果的影响.
主要方法:
- 进行了一项前性,随机的多中心试验,涉及三个1级创伤中心.
- 18-50岁的肌肉骨损伤和Hgb<9g/dL的患者在复苏后稳定,当Hgb下降到7.0g/dL以下时,随机分配到5.5g/dL或7.0g/dL的Hgb输血门.
- 评估的结果包括术后感染率,其他并发症,以及基线,6个月和1年的肌肉骨功能评估得分.
主要成果:
- 65名患者完成了1年的随访.
- 自由的输血策略 (7.0 g/dL) 与更高的感染率 (P = 0.01) 有显著的关联.
- 在自由主义组,表面感染率为7%,而在保守主义组为0% (P <0.01). 在6个月或1年后的功能结果中没有发现显著差异.
结论:
- 保守的PRBC输血门为5.5g/dL对于无症状的年轻创伤患者与相关的肌肉骨损伤是安全的.
- 这种保守的方法导致较低的感染率,而不会增加不良结果或损害功能恢复.
- 这些发现支持在这个特定的患者队列中使用较低的血红蛋白值.
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