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输入用红细胞储存时间与成年危重病患者结局的关系
Age of Red Cells for Transfusion and Outcomes in Critically Ill Adults


D. James Cooper ... 其他 • 2017.11.09

红细胞新鲜程度影响输注效果

 

张敏

武汉协和医院血液科

 

红细胞主要来源于健康供者的无偿捐赠,在中国,则主要来源于大型企事业单位、部队和高校。众所周知,采集的红细胞最多可储存42日。在储存期间,红细胞不断经历代谢、结构或者生物学方面的变化,导致存储损伤。

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摘要


背景

红细胞储存时间是否影响成年危重病患者输血后的死亡率尚未确定。

 

方法

我们进行了一项国际性多中心、随机、双盲试验,分配成年危重病患者输入尽可能新鲜的异体同型红细胞(短期储存组)或者输入标配(可用红细胞中最不新鲜的)的异体同型红细胞(长期储存组)。主要结局是90日死亡率。

 

结果

2012年11月至2016年12月,对5个国家59个中心的4,994例患者进行随机化,主要分析中纳入了4,919例(98.5%)患者。短期储存组的2,457例患者中,输入的红细胞平均储存时间为11.8日。长期储存组的2,462例患者中,输注的红细胞平均储存时间为22.4日。90日时短期储存组中有610例(24.8%)死亡,而长期储存组中有594例(24.1%)死亡(绝对危险度差值,0.7个百分点;95%置信区间[CI],-1.7~3.1;P=0.57)。180日时的绝对危险度差值为0.4个百分点(95% CI,-2.1~3.0;P=0.75)。大多数预设次要指标的结果显示,组间的患者结局没有显著差异。

 

结论

输入用红细胞的储存期对成年危重病患者的90日死亡率没有影响(研究由澳大利亚国家健康与医学研究委员会[Australian National Health and Medical Research Council]等资助;TRANSFUSE在澳大利亚-新西兰临床试验注册中心[Australian and New Zealand Clinical Trials Registry]注册号为ACTRN12612000453886;在ClinicalTrials.gov注册号为NCT01638416)。





作者信息

D. James Cooper, M.D., Zoe K. McQuilten, Ph.D., Alistair Nichol, Ph.D., Bridget Ady, M.Clin.Res.Meth., Cécile Aubron, Ph.D., Michael Bailey, Ph.D., Rinaldo Bellomo, M.D., Dashiell Gantner, M.B., B.S., David O. Irving, Ph.D., Kirsi-Maija Kaukonen, Ph.D., Colin McArthur, M.B., Ch.B., Lynne Murray, B.App.Sci., Ville Pettilä, Ph.D., and Craig French, M.B., B.S., for the TRANSFUSE Investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group*
From the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University (D.J.C., Z.K.M., A.N., B.A., C.A., M.B., R.B., D.G., K.-M.K., L.M., C.F.), the Department of Intensive Care, Alfred Hospital (D.J.C., A.N., D.G.), the Department of Haematology, Monash Health (Z.K.M.), the Department of Intensive Care, Austin Hospital (R.B.), the University of Melbourne (R.B., C.F.), Research and Development, Australian Red Cross Blood Service (D.O.I.), and the Department of Intensive Care, Western Health (C.F.) — all in Melbourne, VIC, Australia; Irish Critical Care Clinical Trials Network, University College Dublin Clinical Research Centre at St. Vincent’s University Hospital, Dublin (A.N.); the Département de Médecine Intensive Réanimation, Brest University Hospital, Brest, France (C.A.); the Department of Anesthesiology (K.-M.K.) and the Division of Intensive Care, Department of Anesthesiology (V.P.), Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki; and the Medical Research Institute of New Zealand and the Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand (C.M.). Address reprint requests to Dr. Cooper at the Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St. Kilda Rd., Melbourne, VIC 3004, Australia, or at jamie.cooper@monash.edu. *A complete list of the Standard Issue Transfusion versus Fresher Red-Cell Use in Intensive Care (TRANSFUSE) Investigators is provided in the Supplementary Appendix, available at NEJM.org.

 

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