输血门和其他指导红细胞输血的策略
Jeffrey L Carson1, Simon J Stanworth2,3,4, Jane A Dennis5
1Division of General Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
The Cochrane database of systematic reviews
|October 20, 2025
概括
限制性红细胞 (RBC) 输血策略显著减少了大多数患者的输血暴露. 虽然在一般情况下是安全的,但自由的策略可能会使神经临床病患者受益,从而保证个性化护理.
科学领域:
- 血液学和输血医学 血液学和输血医学
- 临床结果研究研究
- 基于证据的医学基于证据的医学.
背景情况:
- 由于血液稀缺和输血风险,红细胞 (RBC) 输血的最佳血红蛋白值受到争论.
- 目前的研究探讨了限制性输血策略是否与自由化策略一样有效,并可能成为护理标准.
研究的目的:
- 在所有临床条件下比较30天死亡率和限制性和自由性红细胞输血值之间的其他临床结果.
- 评估越来越多的关于输血策略的证据,包括生理触发因素,与血红蛋白值结合.
主要方法:
- 随机对照试验的系统审查和元分析,比较限制性 (较低的血红蛋白值) 与自由的 (更高的血红蛋白值) 红细胞输血策略.
- 搜索了多个数据库,包括CENTRAL,MEDLINE,Embase和试验登记册,直到2024年10月.
- 使用随机效应模型组合的风险比率和使用Cochrane RoB 1和GRADE评估的偏差风险和证据确定性.
主要成果:
- 限制性输血策略在成人和儿童中在各种环境中将红细胞暴露减少了42% (高确定性证据).
- 整体而言,在限制性和自由的策略之间没有观察到30天死亡率的显著差异 (高确定性证据).
- 备注的例外:限制性策略的消化道出血死亡率较低;自由策略的神经临床病患者的神经学结果更好.
结论:
- 限制性输血策略有效地降低了RBC输血暴露率,而不会增加大多数患者的整体死亡率.
- 自由的输血策略可能对特定人群有益,例如神经临界疾病患者,这表明需要量身定制的方法.
- 未来的研究应该探索超出死亡率的结果,并整合生理参数,以完善各种患者群体的输血指南.
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