Perioperative Red Blood Cell Transfusion: What We Do Not Know.
Perioperative Red Blood Cell Transfusion: What We Do Not Know.
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围手术期红细胞输注：我们所不知道的。
DOI：
10.4103/0366-6999.163384
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发表时间：
2015-09-05
影响因子：
6.1
通讯作者：
Xiong LZ
中科院分区：
文献类型：
--
作者：
Lei C;Xiong LZ
输血可以挽救生命，但也可能增加受伤的风险。本综述的目的是评估长期储存红细胞（RBC）浓缩液输血可能产生的不良反应。本综述使用的数据主要来自截至2015年2月发表的英文PubMed文章。根据与本课题的相关性选择临床和基础研究文章。红细胞在储存过程中发生的离体变化统称为储存损伤。输血后红细胞积存是否有临床意义尚不明确。多个正在进行的前瞻性随机对照试验旨在澄清这一临床问题。我们观察到，与储存红细胞输血相关的不良事件在某些患者群体中很突出，包括创伤、重症监护、儿科和心脏手术患者，这导致了对潜在机制的调查。结果表明，游离血红蛋白毒性、一氧化氮生物利用度降低和游离铁诱导的炎症增加可能在这一过程中起重要作用。目前尚不清楚输注较老的红细胞是否有不良影响，如果有，哪些因素决定了这种临床影响。然而，考虑到输血的规模和广泛的医疗意义，应考虑潜在的预防战略，特别是对易受感染的接受者。
Blood transfusion saves lives but may also increase the risk of injury. The objective of this review was to evaluate the possible adverse effects related to transfusion of red blood cell (RBC) concentrates stored for prolonged periods. The data used in this review were mainly from PubMed articles published in English up to February 2015. Clinical and basic research articles were selected according to their relevance to this topic. The ex vivo changes to RBC that occur during storage are collectively called storage lesion. It is still inconclusive if transfusion of RBC with storage lesion has clinical relevance. Multiple ongoing prospective randomized controlled trials are aimed to clarify this clinical issue. It was observed that the adverse events related to stored RBC transfusion were prominent in certain patient populations, including trauma, critical care, pediatric, and cardiac surgery patients, which leads to the investigation of underlying mechanisms. It is demonstrated that free hemoglobin toxicity, decreasing of nitric oxide bioavailability, and free iron-induced increasing of inflammation may play an important role in this process. It is still unclear whether transfusion of older RBC has adverse effects, and if so, which factors determine such clinical effects. However, considering the magnitude of transfusion and the widespread medical significance, potential preventive strategies should be considered, especially for the susceptible recipients.