不同库存时间红细胞输注对患者预后影响的Meta分析  

Transfusion of Red Blood Cells with Different Duration for Patients' Prognosis: A Meta-Analysis

作　　者：金星[1] 马海平[1] 王江[1] 郑宏[1] 

机构地区：[1]新疆医科大学第一附属医院麻醉科,乌鲁木齐830054

出　　处：《中国循证医学杂志》2014年第3期299-305,共7页Chinese Journal of Evidence-based Medicine

基　　金：新疆维吾尔自治区重点学科项目资助(新教研[2010]7号)

摘　　要：目的系统评价不同库存时间红细胞输注对患者预后的影响，为临床合理用血供理论依据。方法计算机检索TheCochraneLibrary（2013年第3期）、PubMed、Ovid、EMbase、CBM、WanFangData和CNKI，查找有关不同库存时间红细胞输注对患者预后影响的文献，检索时限均为从2002至2013年。同时手T检索相关杂志并追溯纳入文献的参考文献。由2位评价者根据纳入与排除标准独立筛选文献、提取资料和评价纳入研究的方法学质量后，采用RevMan5．0软件进行Meta分析。结果最终纳入10个研究，包括4个病例一对照研究和6个队列研究，共15187例患者。Meta分析结果显示：输注新鲜红细胞组（≤10～18天）的短期死亡率[OR=0．70，95％CI（0．58，0．84），P=0．0001]和院内感染率[OR=0．67，95％CI（0．55，0．81），P〈0．0001]均低于输注陈旧红细胞组（〉14～28天）；对于心脏手术患者，输注新鲜红细胞组的术后肾功能衰竭[OR=0．52，95％CI（0．37，0．73），P=0．0002]和机械通气时间延长（〉72h）[OR=0．54，95％CI（0．45，0．66），P〈0．00001]发生率均低于输注陈旧红细胞组。，结论输注新鲜红细胞较输注陈旧红细胞能显著降低短期死亡率和感染率，且对心脏手术患者，输注新鲜红细胞可显著减少其术后肾衰竭和机械通气时间延长（〉72h）的发生率，改善其预后。受纳入研究数量和质量限制，上述研究尚待开展更多高质量研究加以验证。Objective To systematically review transfusion of red blood cells with different duration for patients＇ prognosis so as to provide evidence for the reasonable blood use in clinic. Methods Databases including The Cochrane Library （Issue 3, 2013）, PubMed, Ovid, EMbase, WanFang Data and CNKI were electrically searched to collect studies published from 2002 to 2013, and relevant periodicals and references of the included studies were also manually retrieved. According to the inclusion and exclusion criteria, related studies were screened, data were extracted, and the quality of in- cluded studies was evaluated by two reviewers independently. Then meta-analysis was conducted using RevMan 5.0 soft- ware. Results A total of 10 studies （including 4 case-control studies and 6 cohort studies） were included, involving 15 187 patients. The results ofmeta-analysis revealed that, transfusion of fresh red cells （ ,〈 10-18 days） was superior to that of old ones （〉14-28 days） in decreasing the short-term mortality （OR=0.69, 95%CI 0.58 to 0.82, P〈0.000 1） and the incidence of hospital infection （OR=0.67, 95%CI 0.55 to 0.81, P〈0.000 1）, and in decreasing the incidences of post-operation kidney failure （OR=0.52 95%CI 0.37 to 0.73, P=0.000 2） and prolonged ventilator,/support （〉72 h） （OR=0.54 95%CI 0.45 to 0.66, P〈0.000 01） for patients with cardiac surgery, all with significant differences. Conclusion Transfusion of fresh red cells （ ≤ 10-18 days） is superior to that of old ones （〉14-28 days） in decreasing the short-term mortality and the incidence of hospital infection, and in decreasing the incidences of post-operation kidney failure and prolonged ventilatory support （〉72 h） for patients with cardiac surgery, which improve prognosis. Due to the limited quality and quantity of the included studies, the aforementioned conclusion needs to be verified by conducting more high quality studies.

关 键 词：红细胞储存损伤 输血 预后 系统评价 META分析 病例一对照研究 队列研究 

分 类 号：R457.1[医药卫生—治疗学]