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急性上消化道出血的输血策略
Transfusion Strategies for Acute Upper Gastrointestinal Bleeding


Càndid Villanueva ... 其他 • 2013.01.03
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摘要


背景

针对急性消化道出血患者进行红细胞输注的血红蛋白阈值一直存在争议。 我们在本文中比较了限制性输血和宽松性输血策略的疗效和安全性。

 

方法

我们招募了921名严重急性上消化道出血的患者,然后随机将461名患者分配到限制性策略输血组 (当血红蛋白水平降到7 g/dL以下时进行输血),另将460名患者分配到宽松性策略输血组(当血红蛋白水平降到9 g/dL以下时进行输血)。根据患者是否存在肝硬化进行分层和随机化。

 

结果

限制性输血组中有225名患者(51%)没有接受输血,宽松性输血组中有61名患者(14%)没有接受输血(P<0.001)。限制性输血组的6周生存概率高于宽松性输血组(95%对91%;限制性输血组的死亡风险比为0.55;95%可信区间[CI],0.33~0.92;P=0.02)。再次出血率在限制性输血组中为10%,在宽松性输血组中为16%(P=0.01),不良事件的发生率为40%比48%(P=0.02)。在消化性溃疡相关出血的亚组中,限制性输血策略组的患者生存概率略高于宽松性输血组的患者(风险比0.70;95% CI,0.26~1.25)。在肝硬化Child–Pugh评分A级或B级的患者亚组中,限制性输血的患者生存概率显著高于宽松性输血的患者(风险比0.30;95% CI,0.11~0.85),但在C级患者亚组中不存在显著差别(风险比1.04;95% CI,0.45~2.37)。在输血后的前5天内,宽松性输血组患者的门静脉梯度压力显著上升(P=0.03),而限制性输血组的患者没有出现这种情况。

 

结论

相对于宽松性策略输血,限制性输血策略可显著改善急性上消化道出血患者的结局(由Fundació Investigació Sant Pau资助;ClinicalTrials.gov注册号为NCT00414713)。





作者信息

Càndid Villanueva, M.D., Alan Colomo, M.D., Alba Bosch, M.D., Mar Concepción, M.D., Virginia Hernandez-Gea, M.D., Carles Aracil, M.D., Isabel Graupera, M.D., María Poca, M.D., Cristina Alvarez-Urturi, M.D., Jordi Gordillo, M.D., Carlos Guarner-Argente, M.D., Miquel Santaló, M.D., Eduardo Muñiz, M.D., and Carlos Guarner, M.D.
From the Gastrointestinal Bleeding Unit, Department of Gastroenterology (C.V., A.C., M.C., V.H.-G., C.A., I.G., M.P., C.A.-U., J.G., C.G.-A., C.G.), Blood and Tissue Bank (A.B., E.M.), and the Semi-Critical Unit (M.S.), Hospital de Sant Pau, Autonomous University, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (C.V., A.C., I.G., C.G.) — all in Barcelona. Address reprint requests to Dr. Villanueva at Servei de Patologia Digestiva, Hospital de la Santa Creu i Sant Pau, Mas Casanovas, 90. 08025 Barcelona, Spain, or at cvillanueva@santpau.cat.

 

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