在部骨折手术后的患者中,基于血红蛋白值的输血实践:一个多中心的回顾性研究
Megan Berube1, Jeffrey M Bortman2, Anica C Law3
1Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
概括
在关节骨折手术后输血最常见的是血红蛋白值为7.0g/dL,超过推的8.0g/dL. 这项研究量化了不同血红蛋白水平的输血实践.
科学领域:
- 整形外科手术 整形外科手术
- 输血医学 输血医学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 在关节骨折手术后输血的最佳血红蛋白值仍然不确定.
- 目前的指导方针建议8.0g/dL的值,但临床实践有所不同.
- 这项研究调查了在血红蛋白值为7.0,8.0和10.0g/dL的输血实践.
研究的目的:
- 为量化在接受关节骨折手术的患者的输血实践,跨越不同的血红蛋白值.
- 为了确定输血率是否在7.0,8.0和10.0g/dL的血红蛋白水平上有显著差异.
- 为优化这一患者群体的输血指南提供证据.
主要方法:
- 利用Premier Inc.数据库对50岁以上的住院患者进行基于索赔的分析,这些患者患有关节骨折和手术.
- 使用局部线性回归的回归不连续性 (RD) 模型.
- 分析患者日来确定最低血红蛋白和输血的管理,计算风险和平均差异与95%的置信区间.
主要成果:
- 分析包括来自93,111名患者的320,194个患者日;9.2%接受了输血.
- 在血红蛋白值为7.0g/dL (19.0个百分点) 时观察到输血使用的统计学上显著增加.
- 输血使用的较小,显著增加发生在8.0g/dL (3.2个百分点),在10.0g/dL时没有显著变化.
结论:
- 在使用7.0g/dL血红蛋白值时,与推的8.0g/dL或自由的10.0g/dL值相比,部骨折手术后输血更频繁.
- 研究结果表明,目前的输血实践可能与既定指导方针不一致.
- 进一步的研究可能会为关节骨折患者提供基于证据的输血策略.
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