限制性输血策略与开放性输血策略对髋关节手术患者预后影响的Meta分析  

Restrictive versus liberal strategy for red blood cell transfusion in hip surgery patients:A systematic review and meta-analysis

作　　者：姜蕾[1] 郝蒙蒙 王璐璐[1] 陈利达[1] 卢宏凯[1] 赵儒 郑超[1] 曹永彤[1] JIANG Lei;HAO Mengmeng;WANG Lulu;CHENG Lida;LU Hongkai;ZHAO Ru;ZHENG Chao;CAO Yongtong(Department of Blood Transfusion,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]中日友好医院输血科,北京100029

出　　处：《中国输血杂志》2020年第10期1067-1073,共7页Chinese Journal of Blood Transfusion

摘　　要：目的评估限制性输血策略与开放性输血策略在髋关节手术中的有效性和安全性。方法计算机检索电子数据库PubMed、Embase and the Cochrane Library,检索词主要为hip,strategy和Red blood transfusion及其相关或相似或相近的词汇。搜索策略:"transfusion OR transfusions OR transfusion strategy OR transfusion threshold"AND"hip OR lower limb"AND"transfusion strategy OR strategy OR restrictive OR liberal"。入选文献包括随机对照试验(RCT)和回顾性队列研究(RCS),试验设置2组:使用较低血红蛋白水平(Hb)作为输血触发阈值(限制性输血策略或输血方案)组,使用较高Hb作为输血触发阈值(开放性输血策略或输血方案组。主要临床结果包括死亡率、谵妄、感染、心血管事件、血栓栓塞事件、脑血管事件、肺栓塞、急性肾衰、30 d再入院率和住院日。使用STATA 14.0统计学软件对数据作统计学分析。统计异质性用卡方检验(Q检验)和I2检验)计算评估;潜在的出版偏倚用Begg和Egger检验计算评估。结果共计纳入有关髋关节手术的8项RCT和4项RCS,含6945个病例。限制性输血组与开放性输血组比较,30 d死亡率(RR=0.77,95%CI 0.65—0.91)、30 d再入院率(RR=0.65,95%CI 0.42—0.99)、90 d死亡率(RR=0.86,95%CI 0.76—0.98)更低而且住院日更短(RR=-0.48,95%CI-0.86—-0.10),但心肌梗死发生率更高(RR=1.69,95%CI 1.05—2.71);住院死亡率、1年死亡率及谵妄、伤口感染、肺部感染、所有感染并发症、充血性心力衰竭、心律失常、血栓栓塞事件、肺栓塞和急性肾衰等症状无明显差异(P>0.05)。结论在髋关节手术中,临床医生需要详细评估患者的病情,除缺血性心血管基础疾病的患者可考虑适当放宽输血阈值外,限制性输血策略是其他患者更优选项。Objective To evaluate the effectiveness and safety of restrictive versus liberal transfusion strategies in patients undergoing hip surgery.Methods The terms as hip,strategy and red blood transfusion were searched using Pubmed,EMBASE and Cochrane Library with a search strategy as transfusion OR transfusions OR transfusion strategy OR transfusion threshold AND(hip OR lower limb)AND(transfusion strategy OR strategy OR restrictive OR liberal).The selected literature were then divided into identify randomized controlled trials(RCTs)group and retrospective cohort studies(RCSs)group,with a lower hemoglobin level as the blood transfusion trigger threshold(restrictive blood transfusion strategy/protocol),and a higher hemoglobin level as the blood transfusion trigger threshold(liberal blood transfusion strategy/protocol),respectively.The clinical outcomes mainly included mortality,delirium,infection,cardiovascular events,cerebrovascular events,thromboembolic events,pulmonary embolism,acute renal failure,readmission rate in 30 days and hospital stay.The data were statistically analyzed using STATA 14.0 software,and statistical heterogeneity was assessed by both Cochran chi-squared test(Q test)and I2 test,and potential publication bias was assessed by both the Begg and Egger tests.Results 8 eligible RCTs and 4 eligible RCSs were included in this study,involving 6945 cases in total.Pooled results revealed no differences in hospital mortality,1-year mortality,delirium,wound infection,pulmonary infection,all complications of infections,congestive heart failure,arrhythmia,thromboembolic event pulmonary embolism,and,acute renal failure between the two groups(P>0.05).The risk of 30-day mortality(RR=0.77,95%CI 0.65—0.91),readmission rate in 30 days(RR=0.65,95%CI 0.42—0.99),the risk of 90-day mortality(RR=0.86,95%CI 0.76—0.98)and the length of hospital stay(RR=-0.48,95%CI-0.86—-0.10)was better in RCTs group than those in RCSs group,except for the incidence of myocardial infarction(RR=1.69,95%CI 1.05—2.71).Conclusion Hip su

关 键 词：髋关节手术 开放性输血 限制性输血 预后 META分析 心血管疾病 

分 类 号：R457.1[医药卫生—治疗学] R687.4[医药卫生—临床医学]