基于血红蛋白的输血策略用于心血管和其他疾病:限制性,自由性,还是没有?
Charles Natanson1, Willard N Applefeld2, Harvey G Klein3
1Critical Care Medicine Department, Clinical Center, and National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD.
Blood
|September 18, 2024
概括
限制性红细胞输血门可能会增加急性冠状动脉综合征 (ACS) 的风险. 建议采用个性化输血策略,而不是采用一种适合所有人的方法,以提高患者安全.
科学领域:
- 血液学 血液学 血液学
- 心脏病学 心脏病学
- 临床实践 临床实践
背景情况:
- 限制性红细胞输血门 (血红素<7-8g/dL) 是住院患者的标准标准,包括患有稳定心血管疾病 (CVD) 患者.
- 现有的指导方针可能基于错误的输血触发试验的误解数据.
研究的目的:
- 重新评估限制性与自由性的红细胞输血策略的安全性.
- 质疑当前的输血实践,并倡导个性化输血治疗.
主要方法:
- 对最近证据的分析表明,在患有稳定心血管疾病和/或急性冠状动脉综合征 (ACS) 的患者中,自由输血策略的安全性得到改善.
- 使用医院数据库和元分析,估计过度的ACS事件归因于限制性输血实践.
主要成果:
- 自由的输血策略与住院患者的稳定心血管疾病和/或ACS的改善安全性有关.
- 限制性输血管理 (<10 g/dL) 将心血管疾病患者新发性ACS的风险增加约2%.
- 据估计,每年有700例多余的骨科手术患者的ACS事件可能与当前的限制性输血实践有关.
结论:
- 目前限制性输血门可能导致不良心血管事件,应该重新考虑.
- 输血治疗应个性化,考虑个体患者的因素,如年龄,临床状况和并发症.
- 未来的输血试验需要强大的设计,包括通常的护理作为控制,以改善临床实践.
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