红细胞输血策略困境在ICU的重症患者:是限制性还是自由的答案?
Ayu Dilia Febriani Wisnawa1, I Wayan Aryabiantara2, Tjokorda Gde Agung Senapathi2
1Pain Management and Intensive Care, Udayana University Hospital, Bali, Indonesia.
概括
与自由主义策略相比,限制性红细胞 (RBC) 输血策略不会显著增加危急病患者的死亡率. 然而,限制性方法减少了红细胞输血需求,并且可能更具成本效益.
科学领域:
- 关键护理医学 关键护理医学
- 血液学 血液学 血液学
- 基于证据的医学基于证据的医学.
背景情况:
- 红细胞 (RBC) 输血是增加血红蛋白的主要方法.
- 红细胞输血的风险和可获得性有很大的不同.
- 输血策略旨在平衡利益与潜在危害.
研究的目的:
- 为了比较限制性与自由的红细胞输血策略.
- 评估对重症监护室 (ICU) 患者死亡率和临床结果的影响.
主要方法:
- 对15项随机对照试验 (RCT) 的元分析,涉及12,439名重症患者.
- 在CENTRAL,PubMed,MEDLINE和ScienceDirect数据库中进行了搜索.
- 使用随机效应模型组合数据;用I2统计数据评估异质性.
主要成果:
- 在限制性和自由的红细胞输血策略之间,死亡率 (ICU或医院) 没有显著差异 (RR 0.92;95% CI 0.78-1.08).
- 观察到最小的异质性 (I2 = 0%).
- 二次临床结果也显示,两种策略之间没有显著差异.
结论:
- 限制性红细胞输血策略与重症患者的死亡率增加无关.
- 限制性策略显著降低了红细胞输血要求.
- 限制性输血方法预计会更具成本效益.
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