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高心脏风险患者的自由或限制性术后输血:顶级随机临床试验

Panos Kougias1, Sherene E Sharath1, Min Zhan2

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科学领域:

  • 心脏病学
  • 输血医学
  • 危急护理医学

背景情况:

  • 目前红细胞输血指南建议输血患者的血红蛋白水平低于7g/dL.
  • 在接受重大手术的高风险心脏病患者中,自由输血策略的安全性尚未得到充分证实.

研究的目的:

  • 将自由和限制性输血策略之间的90天内死亡或严重缺血事件的风险进行比较.
  • 评估经过重大手术并患有术后贫血的高心脏风险患者的结局.

主要方法:

  • 一项随机临床优势试验,涉及1428名接受重大血管或整体手术的高风险心脏病患者.
  • 在手术后血红蛋白< 10 g/ dL 的参与者被随机分配到自由 (输血触发值< 10 g/ dL) 或限制性 (输血触发值< 7 g/ dL) 策略中.

主要成果:

  • 主要结局 (死亡,心肌梗塞,冠状动脉再血管,急性功能衰竭或缺血性中风) 在自由组发生在9. 1%,限制组发生在10. 1% (RR,0. 90;95% CI,0. 65-1. 24).
  • 第二次结局 (心脏并发症,不包括心肌梗塞) 在自由组发生在5. 9%,而限制组发生在9. 9% (RR,0. 59;99% CI,0. 36- 0. 98).

结论:

  • 在接受重大手术的高心脏风险患者中,自由输血策略与限制性策略相比没有降低90天死亡或重大缺血事件的发生率.
  • 自由输血策略与非心肌梗塞心脏并发症的减少有关.