Correlation Between Blood Transfusion and Postoperative Outcomes following Cardiac Surgery: A Systematic Review
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摘要:
目的 系统评价心脏围术期输血与术后近远期结局的关系。 方法 检索中英文文献数据库中1990年1月至2014年12月关于输血和心脏术后结局关系的回顾性病例对照研究, 使用RevMan 5.3软件, 应用Meta分析方法对所纳入文献的研究结果进行定量综合分析。 结果 本研究共纳入13项回顾性病例对照临床研究, 总样本量88 808例, 其中输血组42 991例, 未输血组45 817例。输血组和未输血组的各心脏术后结局指标差异均有统计学意义:30 d死亡率(OR=2.39, 95% CI:1.71~3.34, P < 0.000 01), 1年死亡率(OR=3.08, 95% CI:2.18~4.35, P < 0.000 01), 5年死亡率(OR=1.90, 95% CI:1.42~2.56, P < 0.0001), 缺血事件(OR=2.23, 95% CI:1.71~2.90, P < 0.000 01), 感染(OR=2.18, 95% CI:1.74~2.75, P < 0.000 01)。 结论 围术期输血与心脏手术后近远期死亡率和缺血事件、感染的发生具有明显相关性。 Abstract:Objective To systematically assess the correlation between blood transfusion and postoperative outcomes following cardiac surgery. Methods Databases were searched for retrospective case-control studies on blood transfusion and postoperative outcome after cardiac surgery published in Chinese and English between January 1990 and December 2014. A meta-analysis was performed using RevMan 5.3 for quantitative synthesis of findings from included studies. Results Thirteen retrospective case-control studies including 88 808 patients (42 991 blood transfusion cases, 45 817 non-transfusion cases) were eligible for inclusion. The pooled analysis revealed statistically significant differences in all the postoperative outcomes:30-day mortality (OR=2.39, 95% CI:1.71-3.34, P < 0.000 01), 1-year mortality (OR=3.08, 95% CI:2.18-4.35, P < 0.000 01), 5-year mortality (OR=1.90, 95% CI:1.42-2.56, P < 0.0001), ischemic accident (OR=2.23, 95% CI:1.71-2.90, P < 0.000 01), and infection (OR=2.18, 95% CI:1.74-2.75, P < 0.000 01). Conclusion Perioperative blood transfusion may be strongly related with the risk of postoperative short- and long-term mortality, ischemic events, and infection following cardiac surgery. -
Key words:
- cardiac surgery /
- blood transfusion /
- Meta-analysis
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表 1 纳入研究一般情况
研究及
发表时间病例来源
国家及时间输血组/未
输血组例数血液制品
类型术后结局
指标未行体外循环
手术所占
比例(%)手术类型 随访时间 文献质量
评价Engoren等[7]
2002年美国,
1994-1997659/1256 红细胞 5年死亡率 0 冠状动脉旁路移植术 24~81个月 9/10 Kuduvalli等[5]
2005年英国,
1999-2001940/2084 红细胞 30 d死亡率、1年死亡率、心肌梗死、肾衰竭、中风、纵隔炎 23 冠状动脉旁路移植术 1年 8/10 Koch等[8]
2006年(a)*美国,
1995-20025814/6149 红细胞、血浆、血小板 30 d死亡率,肾衰竭、心脏并发症、严重感染、神经并发症 不详 冠状动脉旁路移植术 30 d 7/10 Koch等[9]
2006年(b)*美国,
1995-20025056/5233 红细胞、血浆、血小板 1、5、10年死亡率 不详 冠状动脉旁路移植术 10年 8/10 Murphy等[1]
2007年英国,
1996-20034908/3689 红细胞 30 d死亡率、住院感染、住院缺血事件、近远期死亡风险 24 冠状动脉旁路移植术、
瓣膜手术7年 8/10 Scott等[10]
2008年美国,
连续3年,具
体不详1069/677 红细胞 30 d死亡率、中风、感染、肾衰竭 不详 冠状动脉旁路移植术 30 d 7/10 Surgenor等[6]
2009年美国,
2001-20043254/5825 红细胞 6个月死亡率、5年死亡率 10.6 冠状动脉旁路移植术、
瓣膜手5年 7/10 van Straten等[11]
2010年美国,
1998-20073597/6828 红细胞 30 d死亡率、大于30 d存活、肾衰竭、中风、纵隔炎、心肌梗死 8.9 冠状动脉旁路移植术 10年(1691±
1058 d),最短
60 d9/10 Dorneles等[12]
2011年巴西,
1996-2009916/3112 红细胞 30 d死亡率、呼吸道感染、纵隔炎、败血症、中风、心肌梗死 3.4 冠状动脉旁路移植术、
瓣膜手术30 d 7/10 Paone等[13]
2012年美国,
2006-201017 720/14 098 红细胞 30 d死亡率 不详 冠状动脉旁路移植术 30 d 8/10 Mikkola等[14]
2012年芬兰,
2008-20102226/983 红细胞、血浆、血小板 中风 不详 冠状动脉旁路移植术 30 d 7/10 Mikkola等[15]
2013年芬兰,
2006-20111332/669 红细胞、血浆、血小板 30 d死亡率、术后3个月死亡、低心排综合征 不详 冠状动脉旁路移植术 至少3个月 8/10 Santos等[16]
2013年巴西,
2009-20101888/1116 红细胞 30 d死亡率、1年死亡率 11.4 冠状动脉旁路移植术 1年 8/10 *a和b用以区分同一研究组在同一年发表的两项研究 -
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