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Updated: Jun 24, 2025

Fixed Volume or Fixed Pressure: A Murine Model of Hemorrhagic Shock
Published on: June 6, 2011
在创伤性脑损伤患者中,自由或限制性输血策略
Alexis F Turgeon1, Dean A Fergusson1, Lucy Clayton1
1From the Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine (A.F.T., M.V., M.S.-O., F. Lauzier), the Department of Social and Preventive Medicine (L.M.), the Department of Surgery, Division of Neurosurgery (P.L.B.), the Department of Medicine (V.L., F. Lauzier), and the Department of Family and Emergency Medicine (M.S.-O.), Faculty of Medicine, Université Laval, the Population Health and Optimal Health Practice Unit, Centre Hospitalier Universitaire de Québec-Université Laval Research Center (A.F.T., L.C., M.-P.P., X.N., L.M., P.L.B., M.V., M.S.-O., O.C., F. Lauzier), and the Department of Anesthesia, Critical Care Medicine Service, Hôpital de L'Enfant-Jésus, Centre Hospitalier Universitaire de Québec-Université Laval (A.F.T., F. Lauzier), Quebec City, QC, Ottawa Hospital Research Institute (D.A.F., S.W.E., T.R., M.T., A.T.), the School of Epidemiology and Public Health (D.A.F., S.W.E., T.R., M.T., A.T.), the Division of Critical Care (S.W.E.), the Division of Hematology (A.T.), and the Division of Palliative Care (P.C.H.), the Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal (L.C.), the Department of Internal Medicine (R.Z.), the Departments of Surgery and of Human Anatomy and Cell Science (F.Z., A.G.), Rady Faculty of Health Sciences, and the Biomedical Engineering Program, Faculty of Engineering (F.Z.), University of Manitoba, and the Department of Medical Oncology-Hematology and the Paul Albrechtsen Research Institute, CancerCare Manitoba (R.Z.), Winnipeg, the Department of Critical Care Medicine, Sunnybrook Health Sciences Center and Sunnybrook Research Institute (D.C.S., N.K.J.A.), and the Interdepartmental Division of Critical Care Medicine, University of Toronto (D.C.S., N.K.J.A., A.R., K.E.A.B., J.M.), Toronto, the Departments of Critical Care Medicine and Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (A.K.), the Departments of Medicine and of Epidemiology and Biostatistics, Western University, London, ON (I.B.), the Departments of Surgery and Critical Care Medicine, McGill University Health Centre, Montreal (K.K.), the Department of Medicine, Faculty of Medicine, and Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC (F. Lamontagne), the Department of Surgery, Division of Neurosurgery, McMaster University, Hamilton Health Sciences, Hamilton, ON (A.A.), the Department of Anesthesia, St. Michael's Hospital, University of Toronto (A.R.), the Applied Health Research Centre, Li Ka Shing Knowledge Institute, and the Department of Critical Care, Unity Health Toronto-St. Michael's Hospital (K.E.A.B., J.M.), Toronto, the Departments of Medicine (A.F.-R.) and Health Research Methods, Evidence and Impact (K.E.A.B.), McMaster University, Hamilton, ON, the Department of Medicine, Division of Critical Care Medicine, Faculty of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver (D.E.G.), the Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton (D.J.K.), Trauma Nova Scotia, Nova Scotia Health, and the Departments of Critical Care, Emergency Medicine, and Anesthesia and Surgery, Dalhousie University, Halifax (R.G.), the Department of Medicine, Division of Neurology, and the Department of Critical Care Medicine, School of Medicine, Queen's University, Kingston, ON (J.G.B.), the Department of Medicine, Centre Hospitalier de l'Université de Montréal, and the Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal (E.C., M.C.), Centre Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) de la Mauricie-et-du-Centre-du-Québec, Trois-Rivières (E.C.), the University of Saskatchewan, College of Medicine, and Saskatchewan Health Authority-Regina Area, Regina (E.S.), and Bruyère Research Institute, University of Ottawa, Ottawa (P.C.H.) - all in Canada; Usher Institute of Population Health Sciences (T.S.W., A.D.) and the Department of Anaesthesia, Critical Care, and Pain Medicine (T.S.W., A.D., J.R.), Edinburgh Medical School, University of Edinburgh, Edinburgh, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford (J.G.), the Department of Critical Care Medicine, Imperial College Healthcare NHS Trust, St. Mary's Hospital, London (V.G.R.), Cardiff University and the University of Wales Hospital, Cardiff (M.W.), Nottingham University Hospitals NHS Trust, Nottingham (D.H.), University Hospitals North Midlands-Royal Stoke Hospital, Stoke-on-Trent (S.K.), the Division of Anaesthesia, Addenbrooke's Hospital, University of Cambridge, Cambridge (F.Z.), James Cook University Hospital, Middlesbrough (J.W.), and the Walton NHS Foundation Trust (P.N.) and the Department of Intensive Care Medicine, Liverpool University Hospitals NHS (T.A.), Liverpool - all in the United Kingdom; Surgical Intensive Care Unit, Anesthesiology Division, Hospital das Clínicas, University of São Paulo Medical School (L.M.M.), and the Intensive Care Unit, Hospital de Amor de Nossa Senhora (L.S.S.) - both in São Paulo; the Department of Anesthesiology and Intensive Care Medicine, University Hospital of Besançon, Besançon (S.P.-F.), Département Anesthésie Réanimation et Médecine Périopératoire, Centre Hospitalier Universitaire (CHU) de Clermont-Ferrand, Clermont-Ferrand (R.C.), Hôpital de Hautepierre, Service d'Anesthésie-Réanimation et Médecine Péri-Opératoire, Hôpitaux Universitaires de Strasbourg, Strasbourg (J.P.), and UR-UM103 IMAGINE, University of Montpellier, Division of Anesthesia and Critical Care, Pain, and Emergency Medicine, Nîmes University Hospital, Montpellier (C.R.) - all in France.
与限制性策略相比,自由的红细胞输血策略并没有改善创伤性脑损伤和贫血严重病患者的神经结果. 这项研究发现,两种输血方法在六个月后的不良结果中没有显著差异.
科学领域:
- 关键护理医学 关键护理医学
- 神经学 神经学
- 输血医学 输血医学
背景情况:
- 对于患有创伤性脑损伤 (TBI) 和贫血的重症患者,最佳的红细胞输血策略仍然不确定.
- 现有证据不足以指导这种特定患者群体的输血决策.
研究的目的:
- 为了比较自由与限制性红细胞输血策略在TBI和贫血的重症患者的神经结果上的有效性.
- 评估输血策略对死亡率,功能独立性,生活质量和受伤后六个月的抑郁症的影响.
主要方法:
- 随机对照试验涉及742名中度至重度TBI和贫血的成年人.
- 患者被分配到自由输血策略 (血红蛋白值≤10 g/dL) 或限制性策略 (血红蛋白值≤7 g/dL).
- 主要结局是6个月的不良结果,使用格拉斯哥结果扩展量表 (GOSE) 进行评估.
主要成果:
- 与限制性策略相比,自由的输血策略并没有显著降低不良神经系统结果的比率 (68.4%vs73.5%).
- 两组之间死亡率或抑郁症没有显著差异.
- 自由主义策略与幸存者在某些功能独立性和生活质量等级上获得更高的分数有关.
结论:
- 在患有TBI和贫血的重症患者中,自由的红细胞输血策略似乎没有改善六个月的神经结果.
- 这些发现表明,目前的输血门可能不会显著改变这个患者群体的神经恢复的轨迹.
- 可能需要进一步的研究来确定可能受益于不同输血方法的特定子组.
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