心脏手术后死亡率和感染率与红细胞、新鲜冰冻血浆，或者血小板输注呈剂量依赖性
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Transfusion of Red Blood Cells, Fresh Frozen Plasma, or Platelets Is Associated With Mortality and Infection After Cardiac Surgery in a Dose-Dependent Manner
背景与目的
目前尚不清楚，除了红细胞外，输注血小板或新鲜冷冻血浆是否与心脏手术后死亡率和感染风险增加有关。
方 法
将在2011年1月1日至2017年6月30日和2013年9月1日至2017年6月30日期间于两个心脏手术中心接受瓣膜手术和/或冠状动脉旁路移植术的患者纳入在这项回顾性研究中。根据倾向性评分匹配对患者进行分层后，我们将输注红细胞、新鲜冰冻血浆或血小板患者的死亡率和感染率与未输注患者的死亡率和感染率进行了比较。我们也比较了接受3种血液制品中的任何一种的患者和根本没有接受输血的患者之间的结果。多变量Logistic回归分析被用来评估输血和结果之间的关联。
结 果
在本研究的8238名患者中，有109名患者（1.3%）死亡，812名患者（9.9%）感染，4937名患者（59.9%）至少输注1种血液制品。任何血型的输血均与较高的死亡率（2.0% VS 0.18%；P<0.01)和感染率有关（13.3% VS 4.8%；P<0.01）。3种血液制品中的每一种都与单位输注引起的死亡率增加有关。（红细胞，优势比1.18，95%可信区间[CI]，1.14-1.22；新鲜冰冻血浆，优势比1.24，95%CI，1.18-1.30；血小板，优势比1.12，95%CI，1.07-1.18）。三种血液制品中任何一种输注3U时都与其死亡率（比值比1.88，95%CI，1.70-2.08）和感染率（比值比1.50，95%CI，1.43-1.57）呈剂量依赖性增加。
结 论
输血红细胞、新鲜冰冻血浆或血小板是死亡和感染的独立危险因素，并且三种血制品的结合与心脏手术后的不良结局呈剂量依赖关系。
原始文献摘要
Yue Ming, Jing Liu, Fengjiang Zhang,et al.Transfusion of Red Blood Cells, Fresh Frozen Plasma, or Platelets Is Associated With Mortality and Infection After Cardiac Surgery in a Dose-Dependent Manner.Anesth Analg,2020;130:488–97.
BACKGROUND: It is unclear whether transfusion of platelets or fresh frozen plasma, in addition to red blood cells, is associated with an increased risk of mortality and infection after cardiac surgery.
METHODS: Patients who underwent valve surgery and/or coronary artery bypass grafting from January 1, 2011 to June 30, 2017 and September 1, 2013 to June 30, 2017 at 2 centers performing cardiac surgery were included in this retrospective study. After stratifying patients
based on propensity score matching, we compared rates of mortality and infection between patients who transfused red blood cells, fresh frozen plasma, or platelets with those who did not receive such transfusions. We also compared outcomes between patients who received any of the 3 blood products and patients who received no transfusions at all. Multivariable logistic regression was used to assess associations between transfusion and outcomes.
RESULTS: Of 8238 patients in this study, 109 (1.3%) died, 812 (9.9%) experienced infection, and 4937 (59.9%) received at least 1 type of blood product. Transfusion of any blood type was
associated with higher rates of mortality (2.0% vs 0.18%; P < .01) and infection (13.3% vs 4.8%; P < .01). Each of the 3 blood products was independently associated with an increase in mortality per unit transfused (red blood cells, odds ratio 1.18, 95% confidence interval [CI],
1.14–1.22; fresh frozen plasma, odds ratio 1.24, 95% CI, 1.18–1.30; platelets, odds ratio 1.12, 95% CI, 1.07–1.18). Transfusing 3 units of any of the 3 blood products was associated with a dose-dependent increase in the incidence of mortality (odds ratio 1.88, 95% CI, 1.70–2.08)
and infection (odds ratio 1.50, 95% CI, 1.43–1.57).
CONCLUSIONS: Transfusion of red blood cells, fresh frozen plasma, or platelets is an independent risk factor of mortality and infection, and combination of the 3 blood products is associated with adverse outcomes after cardiac surgery in a dose-dependent manner.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：任文鑫 编辑：冯玉蓉 审校：王贵龙