红包细胞输血在内镜前或之后对上胃肠道出血患者的死亡率的影响:一个多中心队列研究
Clelia Marmo1, Cristina Bucci2, Marco Soncini3
1CEMAD Centro Malattie Dell'Apparato Digerente, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 00168 Rome, Italy.
Diseases (Basel, Switzerland)
|October 28, 2025
概括
在内镜检查之前输血上部胃肠道出血 (UGIB) 的患者可能会降低死亡率,特别是在严重贫血患者中. 这一发现表明,个性化输血时间对于UGIB管理的更好的结果至关重要.
科学领域:
- 胃肠病学 胃肠病学
- 血液学 血液学 血液学
- 关键护理医学 关键护理医学
背景情况:
- 红细胞输血相对于内镜干预上部胃肠道出血 (UGIB) 的最佳时间尚未确立.
- 目前的临床指南缺乏关于前内镜输血策略的具体建议.
研究的目的:
- 调查红细胞输血时间 (内镜前与内镜后) 与UGIB患者30天死亡率之间的关联.
- 探索基线血红蛋白水平是否会改变前内镜输血对死亡率的影响.
主要方法:
- 一项多中心队列研究的后期分析,涉及3324名UGIB患者.
- 使用倾向性得分匹配来调整混临床和程序变量.
- 根据基线血红蛋白水平,进行了子组分析.
主要成果:
- 在2017年接受输血的患者中,34.7%在内镜检查前接受了红细胞.
- 在整个队列中,先内镜输血与30天死亡率的降低没有显著关联.
- 在基线血红蛋白<7 g/dL (绝对降低6%,p <0.06) 和<8 g/dL的患者中,观察到前内镜输血具有显著的生存益处,特别是当内镜在入院6-12小时之间进行时.
结论:
- 在内镜检查前输血可能有助于降低严重贫血 (Hb < 7 g/dL) 的UGIB患者的30天死亡率.
- 输血时间应该被视为个性化的UGIB管理策略的组成部分.
- 这些发现可能会为未来的临床实践指南提供信息,用于管理上部胃肠道出血.
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