Preoperative Acute Normovolemic Hemodilution for Minimizing Allogeneic Blood Transfusion: A Meta-Analysis
Preoperative Acute Normovolemic Hemodilution for Minimizing Allogeneic Blood Transfusion: A Meta-Analysis
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DOI：
10.1213/ane.0000000000001010
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发表时间：
2015-12-01
影响因子：
5.7
通讯作者：
Yan, Min
中科院分区：
文献类型：
--
作者：
Zhou, Xuelong;Zhang, Chenjing;Yan, Min
背景：先前的研究已经评估了术前急性等容血液稀释（PANH）在减少异体输血需求方面的疗效。然而，迄今为止的结果一直存在争议。在这项研究中，我们试图根据新出现的证据重新评估PANH的有效性和安全性。方法：以血液稀释、自身输血或出血为关键词，检索Medline、EMBASE、ISI Web of Knowledge和Cochrane Central Register of Controlled Trials数据库，检索所有随机对照试验，这些试验检验了PANH在任何类型手术中与未接受PANH的对照患者相比的益处。结果：共纳入63项研究，涉及3819例患者。PANH组围手术期异体输血风险和输注异体红细胞总量均低于对照组（相对风险0.74；95%可信区间0.63 ~ 0.88;P = 0.0006；加权平均差值-0.94单位；95%可信区间-1.27 ~ -0.61单位；P < 0.0001）。但存在显著异质性(I-2 = 79.6%, (2) = 151.95, P < 0.0001；这两个结果的I-2 = 95.3%, (2) = 574.28, P < 0.0001)和发表偏倚（P = 0.001; P = 0.009），限制了关于PANH减少异体输血疗效的结论。两组间围手术期出血量、不良事件和住院时间具有可比性。结论：尽管这些结果表明PANH在减少异体输血方面是有效的，但我们发现了显著的异质性和发表偏倚，这引起了对PANH真正疗效的关注。
BACKGROUND: Previous studies have evaluated the efficacy of preoperative acute normovolemic hemodilution (PANH) in reducing the need for allogeneic blood transfusion. However, the results to date have been controversial. In this study, we sought to reassess the efficacy and safety of PANH based on newly emerging evidence.METHODS: Medline, EMBASE, ISI Web of Knowledge, and Cochrane Central Register of Controlled Trials databases were searched using the key words hemodilution, autotransfusion, or hemorrhage to retrieve all randomized controlled trials examining the benefits of PANH compared with control patients not undergoing PANH in any type of surgery.RESULTS: Sixty-three studies involving 3819 patients were identified. The risk of requiring an allogeneic blood transfusion and the overall volume of allogeneic red blood cell transfused during the perioperative period were reduced in the PANH group compared with the control group (relative risk, 0.74; 95% confidence interval, 0.63 to 0.88; P = 0.0006; weighted mean difference, -0.94 units; 95% confidence interval, -1.27 to -0.61 units; P < 0.0001). However, there was significant heterogeneity (I-2 = 79.6%, (2) = 151.95, P < 0.0001; I-2 = 95.3%, (2) = 574.28, P < 0.0001) and publication bias (P = 0.001; P = 0.009) for both outcomes, limiting conclusions regarding the efficacy of PANH for reducing allogeneic transfusion. Perioperative blood loss, adverse events, and the length of hospitalization were comparable between these groups.CONCLUSIONS: Although these results suggest that PANH is effective in reducing allogeneic blood transfusion, we identified significant heterogeneity and publication bias, which raises concerns about the true efficacy of PANH.