快速更新和修订:在出血患者中进行血栓形成显微镜或旋转血栓形成显微镜指导算法 - - 一个更新的系统性审查与元分析和试验序列分析
A D Kvisselgaard1,2, S A Wolthers3, A Wikkelsø4
1Department of Anesthesia and Intensive Care, Copenhagen University Hospital - Herlev-Gentofte, Copenhagen, Denmark.
Acta anaesthesiologica Scandinavica
|September 26, 2025
概括
输血指导的血栓形成显微镜 (TEG) 或旋转血栓形成显微镜 (ROTEM) 可能会降低出血患者的死亡率和血液制品的使用,但证据的确定性非常低. 需要进一步的研究来证实这些发现.
科学领域:
- 关键护理医学 关键护理医学
- 输血医学 输血医学
- 血液学 血液学 血液学
背景情况:
- 流血患者面临高发病率和死亡率,由于血液静止受损.
- 最佳的静血复苏策略仍然不清楚.
- 血小板造影 (TEG) 和旋转性血小板造影 (ROTEM) 具有指导输血治疗的潜力.
研究的目的:
- 评估TEG/ROTEM引导输血与出血患者的标准护理的益处和风险.
- 从随机对照试验 (RCT) 中综合证据,进行更新的系统性审查.
- 评估对死亡率的影响,血液制品的使用,血液损失和重新干预.
主要方法:
- 系统审查和 RCT 的元分析 坚持 Cochrane,PRISMA 和 GRADE 的指导方针.
- 在五个主要数据库中进行全面的文献搜索.
- 包括儿科和成人患者,以死亡率为主要结局.
主要成果:
- 包括35个RCT (n=3096),主要是选择性心脏手术.
- 由TEG/ROTEM指导的算法显著降低了死亡率 (RR 0.76) 和输血FFP (RR 0.52) 和血小板 (RR 0.69).
- 观察到手术重新干预 (RR 0.63) 和出血量 (SMD -0.31) 的显著减少,证据确定性非常低.
结论:
- 通过TEG/ROTEM引导的输血可以减少死亡率,出血,以及需要血液制品和重新干预的需要.
- 这些益处的证据确定性非常低,主要是基于成人心脏手术患者.
- 需要进一步进行高质量的研究来证实这些发现并指导临床实践.
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