外伤性脑损伤的输血实践：随机对照试验的系统回顾和荟萃分析。

IF 6 1区医学 Q1 CRITICAL CARE MEDICINE Critical Care Medicine Pub Date : 2025-04-01 Epub Date: 2025-01-29 DOI:10.1097/CCM.0000000000006585

Anna Laura Lima Larcipretti, Ofonime Chantal Udoma-Udofa, Fernando Cotrim Gomes, Jéssica Sales de Oliveira, Elizabet Taylor Pimenta Weba, Deivyd Vieira Silva Cavalcante, Madhav Kiritbhai Dharaiya, Matheus de Andrade Bannach

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引用次数: 0

摘要

目的：平衡创伤性脑损伤（TBI）患者输血的氧气需求、神经系统预后和全身并发症是具有挑战性的。本综述比较了TBI患者的自由输血和限制性输血策略。数据来源：从成立到2024年10月检索电子数据库。研究选择：我们纳入了比较TBI患者自由和限制性输血策略的随机对照试验。数据提取：数据由两个审阅者使用预定义的表单提取。数据综合：我们纳入了5项研究，共1533例患者：769例（50.2%）在自由输血组，764例（49.8%）在限制输血组。格拉斯哥结局量表有利组间无显著差异(风险比[RR]， 1.16；95% CI, 1.00-1.34)，尽管留一分析显示该终点具有显著性(RR, 1.24；95% ci, 1.06-1.45)。住院死亡率无显著差异(RR, 0.98；95% CI, 0.76-1.27)，随访死亡率(RR, 1.03；95% CI, 0.82-1.28)， ICU的死亡率(RR, 1.00；95% CI, 0.73-1.37)，感染率(RR, 1.08；95% CI, 0.95-1.23)，血栓栓塞事件(RR, 1.79；95% CI, 0.74-4.31)、住院时间（LOS）(平均差[MD]， -1.45；95% CI, -4.85至1.96)或ICU LOS (MD, -0.47；95% CI, -3.84至2.91)。自由输血策略组急性呼吸窘迫综合征患病率显著高于对照组(RR, 1.78；95% CI, 1.06-2.98)，每位患者接受更多的血单位(MD, 2.62；95% ci, 1.90-3.33)。结论：我们的研究结果表明，自由输血策略比限制性输血策略能获得更好的神经系统预后。未来的研究应该检查并发症的概况和使用9g /dL阈值的影响。我们提倡修订目前的指南，将9 g/dL作为TBI患者输血的标准阈值。

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Transfusion Practices in Traumatic Brain Injury: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Objectives: Balancing oxygen requirements, neurologic outcomes, and systemic complications from transfusions in traumatic brain injury (TBI) patients is challenging. This review compares liberal and restrictive transfusion strategies in TBI patients.

Data sources: Electronic databases were searched from inception to October 2024.

Study selection: We included randomized controlled trials comparing liberal and restrictive transfusion strategies in TBI patients.

Data extraction: Data were extracted by two reviewers using predefined forms.

Data synthesis: We included five studies with 1,533 patients: 769 (50.2%) in the liberal transfusion group and 764 (49.8%) in the restrictive group. There were no significant differences between groups favorable Glasgow Outcome Scale (risk ratio [RR], 1.16; 95% CI, 1.00-1.34), although a leave-one-out analysis demonstrated significance in this endpoint (RR, 1.24; 95% CI, 1.06-1.45). No significant difference was found regarding hospital mortality (RR, 0.98; 95% CI, 0.76-1.27), mortality at follow-up (RR, 1.03; 95% CI, 0.82-1.28), mortality in the ICU (RR, 1.00; 95% CI, 0.73-1.37), infection rates (RR, 1.08; 95% CI, 0.95-1.23), thromboembolic events (RR, 1.79; 95% CI, 0.74-4.31), hospital length of stay (LOS) (mean difference [MD], -1.45; 95% CI, -4.85 to 1.96), or ICU LOS (MD, -0.47; 95% CI, -3.84 to 2.91). The liberal transfusion strategy group had a significantly higher prevalence of acute respiratory distress syndrome (RR, 1.78; 95% CI, 1.06-2.98) and received more blood units per patient (MD, 2.62; 95% CI, 1.90-3.33).

Conclusions: Our findings suggest that a liberal transfusion strategy results in better neurologic outcomes than a restrictive approach. Future research should examine the complication profile and the effects of using a 9 g/dL threshold. We advocate for revising current guidelines to establish 9 g/dL as the standard threshold for transfusions in TBI patients.

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来源期刊

Critical Care Medicine 医学-危重病医学

CiteScore

16.30

自引率

5.70%

发文量

728

审稿时长

2 months

期刊介绍： Critical Care Medicine is the premier peer-reviewed, scientific publication in critical care medicine. Directed to those specialists who treat patients in the ICU and CCU, including chest physicians, surgeons, pediatricians, pharmacists/pharmacologists, anesthesiologists, critical care nurses, and other healthcare professionals, Critical Care Medicine covers all aspects of acute and emergency care for the critically ill or injured patient. Each issue presents critical care practitioners with clinical breakthroughs that lead to better patient care, the latest news on promising research, and advances in equipment and techniques.