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在成年人进行非心脏手术时的术后输血实践

Michael Verret¹, Manoj Lalu², Daniel I Sessler³

¹Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Université Laval, Québec city, Québec, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; CHU de Québec-Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), CHU de Québec-Université Laval, Québec city, Québec, Canada.

Transfusion medicine reviews

|July 14, 2024

概括

在非心脏手术患者的红细胞 (RBC) 输血在六年内下降. 尽管采取了限制性策略,但医院和国家之间发生了大量无法解释的输血实践差异.

科学领域:

麻醉学麻醉学
输血医学输血医学
外科手术的结果

背景情况:

红细胞 (RBC) 输血在手术患者中很常见,以控制出血和贫血.
目前在非心脏外科手术中对外科手术期间红细胞输血的最佳实践进行了辩论,目前对当前实践的数据有限.
需要对外科手术期间的输血实践进行全面评估.

研究的目的:

在接受非心脏手术的患者中,描述外科手术期间的血红蛋白水平和红细胞输血实践.
分析不同手术类型,中心和国家的输血实践的变化.
评估这些变异与患者死亡率和并发症的关联.

主要方法:

对39222名年龄≥45岁,接受住院非心脏手术的患者进行前性队列研究 (VISION).
用于分析输血实践中的变异的等级混合模型.
嵌套脆弱生存模型用于评估与死亡率和并发症的关联.

主要成果:

16.1%的患者接受了手术后红细胞输血,在6年内从20%降至13%.
输血率因手术类型而异 (小手术6.4%,骨科手术31.5%).
在医院 (3.7%-27.3%) 和国家 (0.4%-25.3%) 之间观察到输血实践的大量不明原因变化,即使在调整患者因素后也是如此.

结论:

虽然限制性输血策略似乎很常见,但在非心脏外科手术中,红细胞输血实践存在相当大的不明原因的变化.
医院和国家层面的因素显著影响术后输血实践.
需要进一步的研究来理解和标准化红细胞输血实践,以优化患者的治疗结果.

关键词:

贫血贫血是一种疾病.互动互动互动互动死亡率死亡率死亡率外科手术手术手术输血输血输血是指输血.

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