在儿科外科手术期急性贫血中输血目标和不良事件
Lindsay L Warner1, Leanne Thalji1, Lindsay R Hunter Guevara1
1Department of Anesthesiology and Perioperative Medicine (Drs L. Warner, Thalji, Hunter Guevara, M. Warner, Kor, D. Warner, and Nemergut) and Division of Biomedical Statistics and Informatics (Mr Hanson), Mayo Clinic, Rochester, MN, United States of America.
Journal of clinical anesthesia
|February 3, 2024
概括
在接受非心脏手术的儿童中,输血后血红蛋白水平与临床结果没有相关性,除了需要重新输血. 许多儿科患者在手术前患有贫血,这表明有机会进行手术前健康优化.
科学领域:
- 儿科手术 儿科手术
- 输血医学 输血医学
- 贫血管理 贫血管理
背景情况:
- 在儿科手术中评估红细胞输血的充分性对于患者的结果至关重要.
- 输血前的血红蛋白水平经常被用作触发剂,但在急性手术出血时可能无法获得.
- 手术后的血红蛋白度提供了对输血有效性的潜在更可靠的指标.
研究的目的:
- 确定输血前和输血后血红蛋白度和非心脏手术的儿科患者的临床结果之间的关联.
- 评估初始术后血红蛋白水平是否预测了不良结果或需要进一步输血.
主要方法:
- 对接受非心脏手术的儿科患者进行了回顾性观察性队列研究,这些患者接受了手术内红细胞输血.
- 分析包括从2008年1月到2018年12月的超过741个程序.
- 使用多变量回归建模来评估血红蛋白水平与诸如无医院日,ICU入院,机械通风和传染性并发症等结果之间的关联.
主要成果:
- 初始术后血红蛋白下降1g/dL与需要在24小时内输血的可能性更高有关 (OR,1.62;P <.001).
- 在术后血红蛋白度和无住院日,ICU入院,机械通风或传染性并发症之间没有发现显著的关联.
- 大多数输血的儿科患者 (68%) 呈现了手术前的贫血.
结论:
- 术后血红蛋白度与输血儿科患者的临床结果无关,除了需要随后输血外.
- 手术前贫血的高患病率表明,在非心脏手术之前优化患者健康的关键窗口.
- 专注于术前贫血管理可能会改善儿科手术患者的术后护理.
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