输注血液制品与心脏术后结局相关性的系统分析

李晓凤; 张超纪; 刘剑州; 马国涛; 刘兴荣; 苗齐

doi:10.3969/j.issn.1674-9081.2016.06.005

输注血液制品与心脏术后结局相关性的系统分析

Correlation Between Blood Transfusion and Postoperative Outcomes following Cardiac Surgery: A Systematic Review

摘要

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.

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