心脏外科手术中，单独输注血小板是否对术后出血和预后不良有影响?
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Does a Platelet Transfusion Independently Affect Bleeding and Adverse Outcomes in Cardiac Surgery?
背景与目的
关于血小板输注对若干结果影响的报道尚有争议。本研究的目的是评估术中输注血小板对心脏手术病人出血和预后的影响。
方 法
23860例心脏手术病人被纳入观察性研究中进行分析。早期接受血小板输注治疗的患者（心肺分流术后仍在手术室)，没有输注其他血液制品，被定义为干预组。通过将干预组与绝大多数早期输血的患者1：3相匹配倾向得分，确定参考组。
结 果
干预组169名患者和参考组507名患者。研究人员观察了这些组间再干预、血栓栓塞并发症、感染、器官衰竭和死亡率并无差异。与对照组相比，干预组患者的出血更少，血管活性药物需求更多，机械通气延长92（169）（54％），而507（45％;优势比，1.47; 94％CI，1.03至2.11），延长重症监护95（169例（56％））与507例中的240例（46％;优势比，1.49; 95％CI，1.04至2.12），169（44％）的红细胞75与507中的145（34％;优势比，1.55; 95％CI，1.08至2.23） 血浆中29例为169例（17％），而507例为7.3例（7.3％;优势比为2.63; 95％CI为1.50-4.63），血小板72例为169例（43％）参考组则是507中的25个（4.3％;优势比，16.4; 95％CI，9.3-28.9）。
结 论
在这项回顾性分析中，在手术室接受血小板输注的心脏手术患者的失血量较低，更需要血管活性药物，延长机械通气，延长重症监护和术后血液制品。然而，早期的血小板输注与再狭窄、血栓栓塞并发症、感染、器官衰竭或死亡无关。
原始文献摘要
van Hout F M, Hogervorst E K, Rosseel P M, et al. Does a Platelet Transfusion Independently Affect Bleeding and Adverse Outcomes in Cardiac Surgery?[J]. Anesthesiology, 2017, 126(3):1
Background: Conflicting results have been reported concerning the effect of platelet transfusion on several outcomes. The aim of this study was to assess the independent effect of a single early intraoperative platelet transfusion on bleeding and adverse outcomes in cardiac surgery patients.
Methods: For this observational study, 23,860 cardiac surgery patients were analyzed. Patients who received one early (shortly after cardiopulmonary bypass while still in the operating room) platelet transfusion, and no other transfusions, were defined as the intervention group. By matching the intervention group 1:3 to patients who received no early transfusion with most comparable propensity scores, the reference group was identified.
Results: The intervention group comprised 169 patients and the reference group 507. No difference between the groups was observed concerning reinterventions, thromboembolic complications, infections, organ failure, and mortality. However,patients in the intervention group experienced less blood loss and required vasoactive medication 139 of 169 (82%) versus 370 of 507 (74%; odds ratio, 1.65; 95% CI, 1.05 to 2.58), prolonged mechanical ventilation 92 of 169 (54%) versus 226 of 507 (45%; odds ratio, 1.47; 94% CI, 1.03 to 2.11), prolonged intensive care 95 of 169 (56%) versus 240 of 507 (46%; odds ratio,1.49; 95% CI, 1.04 to 2.12), erythrocytes 75 of 169 (44%) versus 145 of 507 (34%; odds ratio, 1.55; 95% CI, 1.08 to 2.23), plasma 29 of 169 (17%) versus 23 of 507 (7.3%; odds ratio, 2.63; 95% CI, 1.50–4.63), and platelets 72 of 169 (43%) versus 25 of 507 (4.3%; odds ratio, 16.4; 95% CI, 9.3–28.9) more often compared to the reference group.
Conclusions: In this retrospective analysis, cardiac surgery patients receiving platelet transfusion in the operating room experienced less blood loss and more often required vasoactive medication, prolonged ventilation, prolonged intensive care, and blood products postoperatively. However, early platelet transfusion was not associated with reinterventions, thromboembolic complications, infections, organ failure, or mortality.
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