基于倾向性评分匹配法探讨血流动力学稳定的非静脉曲张性上消化道出血患者红细胞输注阈值  

Exploration for the Transfusion Threshold of Red Blood Cell in Hemodynamically Stable Patients with Non-variceal Upper Gastrointestinal Bleeding Based on Propensity Score Matching Method

作　　者：冯志文 杨健[1] 黄伟文[1] 覃美艳 FENG Zhi-wen;YANG Jian;Huang Weiwen(Liuzhou Municipal Liutie Central Hospital,545007)

机构地区：[1]柳州市柳铁中心医院,545007

出　　处：《临床输血与检验》2023年第1期107-111,共5页Journal of Clinical Transfusion and Laboratory Medicine

基　　金：广西卫健委科研课题(No.Z20200264)资助。

摘　　要：目的基于倾向性评分匹配法评价血流动力学稳定的非静脉曲张性上消化道出血患者(non-variceal upper gastrointestinal bleeding,NVUGIB)采用60g/L输血阈值的安全性和可行性。方法选取2019年1月~2022年6月在本院诊断为NVUGIB并输注红细胞患者为研究对象,根据输血前血红蛋白浓度分为观察组(60g/L输血阈值组)和对照组(70g/L阈值组),采用1∶2最邻近匹配法进行匹配后,比较两组患者预后之间的差异。结果倾向性评分匹配后观察组成功匹配患者77例,对照组成功匹配121例,观察组与对照组在主要临床结局30天死亡率(6.5%vs.4.1%,RR=1.234,95%CI0.657~2.317,P=0.684)和30天再出血率(7.8%vs.11.6%,RR=0.859,95%CI0.629~1.172,P=0.390)之间的差异无统计学意义,两组患者在肺部感染率、红细胞用量、输血前后Hb差值、住院日长之间的差异无统计学意义(P>0.05),观察组与对照组在输血后血红蛋白浓度之间的差异有统计学意义(差值为-6.01,95%CI-7.91~-4.12,P<0.001)。结论血流动力学稳定的NVUGIB患者采用60 g/L阈值输血的预后与70 g/L阈值相近,在临床实践中具有可行性。Objective To evaluate the safety and feasibility of using a 60 g/L transfusion threshold in hemodynamically stable patients with non-variceal upper gastrointestinal bleeding based on the propensity score matching method.Methods Patients diagnosed as NVUGIB and transfused red blood cells in our hospital from January 2019 to June 2022 were selected for the study,the patients were divided into an observation group(60 g/L transfusion threshold group)and a control group(70 g/L transfusion threshold group)according to the hemoglobin concentration before transfusion.After matching with the 1∶2 nearest neighbor matching,the clinical outcomes were compared between the two groups.Results After propensity score matching,77 patients were successfully matched in the observation group and 121 patients were matched in the control group,there was no significant difference in 30-day mortality(6.5%vs.4.1%,RR=1.234,95%CI 0.657~2.317,P=0.684)and 30-day rebleeding(7.8%vs.11.6%,RR=0.859,95%CI 0.629~1.172,P=0.390)between the observation group and the control group in the primary clinical outcomes,the differences in lung infection rate,red blood cell consumption,the difference between Hb concentration before transfusion and after transfusion,and length of hospital stay between the two groups were not significant(P>0.05),the difference of hemoglobin concentration between the two groups after blood transfusion was significant(difference=-6.01,95%CI-7.91~-4.12,P<0.001).Conclusion The clinical outcomes of hemodynamically stable NVUGIB patients who were transfused with a 60 g/L threshold were similar to that of patients with a 70 g/L threshold,it is feasible in clinical practice.

关 键 词：倾向性评分匹配法 血流动力学稳定 非静脉曲张性上消化道出血 红细胞 输血阈值 

分 类 号：R457.1[医药卫生—治疗学]