【原】術(shù)前使用促紅細(xì)胞生成素對手術(shù)患者輸血率的影響:系統(tǒng)回顧和Meta分析

罌粟花anesthGH 2021-07-21

展開全文

本公眾號每天分享一篇最新一期Anesthesia & Analgesia等SCI雜志的摘要翻譯，敬請關(guān)注并提出寶貴意見

Impact of Preoperative Erythropoietin on Allogeneic Blood Transfusions in Surgical Patients: Results From a Systematic Review and Meta-analysis

背景與目的

促紅細(xì)胞生成素（EPO）等促進紅細(xì)胞生成的藥物已被用作患者血液管理計劃的一部分，以減少甚至避免異體輸血。我們回顧了相關(guān)文獻(xiàn)來評估術(shù)前使用促紅細(xì)胞生成素對圍術(shù)期異體輸血風(fēng)險的影響。

方法

本次研究涉及一系列評估術(shù)前促紅細(xì)胞生成素使用的系統(tǒng)回顧和Meta分析。主要評估指標(biāo)是異體輸血在患者住院期間的發(fā)生率。次要指標(biāo)包括異體輸血(即術(shù)中、術(shù)后)、術(shù)中估計失血量、圍術(shù)期血紅蛋白水平、住院時間和血栓栓塞并發(fā)癥發(fā)生率。

結(jié) 果

32項研究(n=4750名患者)被納入最終分析，將術(shù)前使用EPO的患者(n=2482)與對照組(n=2268)進行比較。心臟手術(shù)和骨科手術(shù)患者術(shù)前使用促紅細(xì)胞生成素與異體輸血的發(fā)生率顯著降低相關(guān)。與對照組相比，術(shù)前應(yīng)用EPO可顯著減少術(shù)中、術(shù)后和護理階段的異體輸血發(fā)生率。但組間血栓栓塞并發(fā)癥發(fā)生率無明顯差異。

結(jié) 論

術(shù)前使用促紅細(xì)胞生成素可顯著減少圍術(shù)期異體輸血發(fā)生率。此外，我們的研究表明，術(shù)前使用促紅細(xì)胞生成素不會增加血栓栓塞并發(fā)癥的發(fā)生風(fēng)險。

原始文獻(xiàn)摘要

Brian C. Cho, MD, Jessica Serini, MD,Andres Zorrilla-Vaca, et al. Impact of Preoperative Erythropoietin on Allogeneic Blood Transfusions in Surgical Patients: Results From a Systematic Review and Meta-analysis. Anesthesia-Analgesia, 2019,128, 981-992.

BACKGROUND: Erythropoietic-stimulating agents such as erythropoietin have been used as part of patient blood management programs to reduce or even avoid the use of allogeneic blood transfusions. We review the literature to evaluate the effect of preoperative erythropoietin use on the risk of exposure to perioperative allogeneic blood transfusions.
METHODS: The study involved a systematic review and meta-analysis of randomized controlled trials evaluating the use of preoperative erythropoietin. The primary outcome was the reported incidence of allogeneic red blood cell transfusions during inpatient hospitalizations. Secondary outcomes included phase-specific allogeneic red blood cell transfusions (ie, intraoperative, postoperative), intraoperative estimated blood loss, perioperative hemoglobin levels, length of stay, and thromboembolic events.
RESULTS: A total of 32 randomized controlled trials (n = 4750 patients) were included, comparing preoperative erythropoietin (n = 2482 patients) to placebo (n = 2268 patients). Preoperativeerythropoietin is associated with a significant decrease in incidence of allogeneic blood transfusions among all patients (n = 28 studies; risk ratio, 0.59; 95% CI, 0.47–0.73; P < .001) as well as patients undergoing cardiac (n = 9 studies; risk ratio, 0.55; 95% CI, 0.37–0.81; P = .003) and elective orthopedic (n = 5 studies; risk ratio, 0.36; 95% CI, 0.28–0.46; P < .001) surgery compared to placebo, respectively. Preoperative erythropoietin was also associated with fewer phase-specific red blood cell transfusions. There was no difference between groups in incidence of thromboembolic events (n = 28 studies; risk ratio, 1.02; 95% CI, 0.78–1.33; P = .68).
CONCLUSIONS: Preoperative erythropoietin is associated with a significant reduction in perioperative allogeneic blood transfusions. This finding is also confirmed among the subset of patients undergoing cardiac and orthopedic surgery. Furthermore, our study demonstrates no significant increase in risk of thromboembolic complications with preoperative erythropoietin administration.