限制性输血与自由输血策略对小儿心脏手术后病死率影响的Meta分析  

Meta-analysis on effect of restrictive blood transfusion versus liberal blood transfusion strategy on postoperative mortality of pediatric patients undergoing cardiac surgery

作　　者：张慧[1] 吴耀华[1] 郝泉水 Zhang Hui;Wu Yaohua;Hao Quanshui(Department of Anesthesiology,Huanggang Central Hospital,Huanggang 438000,Hubei,China)

机构地区：[1]黄冈市中心医院麻醉科,湖北黄冈438000

出　　处：《中国中西医结合急救杂志》2022年第3期306-310,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：湖北省卫生健康科研项目(WJ2021M084);湖北省黄冈市科技计划项目(XQY2019000014)。

摘　　要：目的 采用Meta分析评价限制性输血与自由输血策略对接受心脏手术患儿病死率的影响.方法 计算机检索美国国立医学图书馆PubMed数据库、荷兰医学文摘Embase数据库、科学网(Web of Science)、中国生物医学文献服务系统(SinoMed)、维普、中国知网及万方数据库中有关患儿心脏术中接受输血治疗的随机对照试验(RCT),检索时间均从建库至2021年7月.由2名研究者按照纳入排除标准筛选文献、提取资料,2名评价员独立对纳入文献的质量进行评价,采用RevMan 5.3进行Meta分析.比较限制性输血与自由输血策略对小儿心脏术后30 d病死率、小儿重症监护病房(PICU)住院时间、总住院时间、脉搏血氧饱和度(SpO2)和动脉血氧分压(PaO2)影响的差异;并基于30 d病死率绘制漏斗图分析发表偏倚.结果 最终纳入5个RCT共497例患者.Meta分析结果显示,限制性输血与自由输血策略术后30 d病死率〔相对危险度(RR)=1.06,95%可信区间(95%CI)为0.45~2.50,P=0.89〕、总住院时间〔均数差(MD)=0.82,95%CI为-0.41~2.06,P=0.19〕、SpO2(MD=^(-1).35,95%CI为-3.58~0.88,P=0.23)和PaO2(MD=-3.18,95%CI为-9.32~2.97,P=0.58)比较差异均无统计学意义;但采用限制性输血策略术后PICU住院时间较自由输血策略明显延长(MD=0.35,95%CI为0.13~0.57,P=0.002).绘制漏斗图对术后30 d病死率进行发表偏倚定性分析,结果显示,各文献两侧分布对称,表明文献发表偏倚对研究结果的影响较小.结论 小儿心脏手术围术期采用限制性输血和自由输血策略对预后影响无显著差异,但限制输血会延长PICU的住院时间.Objective To evaluate the effect of restrictive blood transfusion versus liberal blood transfusion strategy on mortaliy of pediatric patients undergoing cardiac surgery by using Meta-analysis.Methods A computer was_used to retrieve literatures regarding randomized contrlled clinical trials(RCT)including restrictive blood transfusion compared to liberal blood transfusion for pediatric patients undergoing cardiac surgery from PubMed database of US National Library of Medicine,EMbase database of Netherlands Medical Abstract,Web of Science,Chinese Biomedical Literature Service System(SinoMed),VIP,China National Knowledge Intermet(CNKI)and Wanfang databases in the periods from their years of establishment up to July 2021.The literature screening,data extraction and inclusion bias evaluation were independently conducted by 2 evaluators according to the quality inclusion and exclusion criteria.Then,RevMan 5.3 was used for Meta-analysis.The diferences in patients outcomes of 30-day mortality after surgery,pediatric intensive care unit(PICU)retention time,total length of hospital stay,the levels of pulse oxygen saturation(SpO_(2))and arterial parial pressure of oxygen(PaO_(2))with restrictive or liberal transfusion strategy were compared.Based on the outcome of 30-day mortality afer surgery,a funnel plot was drawn to detect publication bias.Results Five RCT studies involving 497 patients were finally included in this Meta-analysis.The Meta-analysis results showed no significant dfference in the restrictive blood transfusion group and liberal blood transfusion group regarding the 30-day mortality after surgery[risk ratio(RR)=1.06,95%confidence interval(95%C)was 0.45-2.50,P=0.89],total length of hospital stay[mean dfference(MD)=0.82,95%C/was-0.41 to 2.06,P=0.19]j,SpO_(2)(MD=-1.35,95%CI was 3.58 to 0.88,P=0.23)and Pa0,(MD=3.18,95%CI was 9.32 to 2.97,P=0.58),but PICU retention time after surgery in the restrictive blood transfusion group was significantly longer than that of liberal blood transfusion group(MD=0.35,95%C/was 0.

关 键 词：输血 小儿心脏手术 病死率 META分析 

分 类 号：R614[医药卫生—麻醉学]