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术后血红蛋白降低与输血结果之间的关联在接受心脏动手术的患者中:来自两个中国心脏中心的观察性研究
Junhui He1, Xinhao Liu1, Li Zhou1
1Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China.
Heliyon
|September 30, 2024
概括
心脏手术后显著的外科手术期间血红蛋白降低 (ΔHb) 会增加风险. 对于≥50%或≥30% (贫血) 的患者,应仔细考虑输血策略,以优化结果.
科学领域:
- 心脏病学 心脏病学
- 输血医学 输血医学
- 关键护理医学 关键护理医学
背景情况:
- 外科手术期间血红蛋白降低 (ΔHb) 对红细胞 (RBC) 输血风险和心脏手术后益处的影响尚不清楚.
- 了解这种关系对于优化患者管理和输血协议至关重要.
研究的目的:
- 调查术前血红蛋白降低 (ΔHb) 与心脏手术后不良结果之间的关联.
- 评估红细胞输血策略如何根据ΔHb的程度和手术前贫血状况改变这些风险.
主要方法:
- 追溯分析了8186名接受门手术和/或冠状动脉旁路移植的成年患者.
- 探索 ΔHb (相对于手术前的水平和术后的最低点) 与复合结果 (死亡率,心脏病发作,中风,AKI) 的相关性.
- 使用多变量逻辑回归,受限制的立方线条和逐块线性模型进行分析.
主要成果:
- 在没有手术前贫血的患者中,ΔHb ≥50%的复合结局风险升高 (aOR 1.95).
- 对于那些 ΔHb ≥50%的人来说,≤4个红细胞单位似乎具有保护性,而>6个单位增加了风险.
- 在患有手术前贫血的患者中,ΔHb ≥30%显著增加风险 (aOR 1.61),输血效应与非贫血组相似.
结论:
- 术后血红蛋白降低 (ΔHb) 显著影响心脏手术后红细胞输血的风险效益平衡.
- 输血门和数量应根据ΔHb水平和手术前贫血状态进行个性化,以减轻不良结果.
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