Safe and successful restriction of transfusion in burn patients
Safe and successful restriction of transfusion in burn patients
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DOI：
10.1097/01.bcr.0000245494.45125.3e
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发表时间：
2006-11-01
影响因子：
1.4
通讯作者：
Cartotto, Robert
中科院分区：
文献类型：
--
作者：
Kwan, Peter;Gomez, Manuel;Cartotto, Robert
烧伤患者输血的可接受策略尚未明确确定。1999年，我们在烧伤中心根据经验采用了7.0 g/dl或更高的血红蛋白（Hb）输血触发。本研究的目的是评估这种限制性输血策略的效果。回顾性比较1999 - 2004年接受治疗的TBSA ≥ 20%的成人（限制性组; REST）与我们采用限制性输血策略之前接受治疗的患者（1997-1998年：自由组; LIB）。REST组（n = 135，年龄42 ± 17岁，%TBSA烧伤37 ± 14，吸入性损伤发生率26%）与LIB组（n = 37，年龄42 ± 16岁，%TBSA烧伤38 ± 17，吸入性损伤发生率35%）无显著差异。REST组触发输血的Hb为7.1 +/- 1.2 g/dl，而LIB组为9.2 +/- 2.1 g/dl（P <0.001）。REST组每天接受的血液单位明显少于LIB组。REST组患者的器官功能明显更好，两组之间的急性心肌梗死发生率没有差异。REST组的30天死亡率显著较低（19% vs 38%; P = 0.03），总体住院死亡率也是如此（22% vs 46%; P = 0.003）。输血限制似乎是安全的，并导致在这组烧伤患者中输血较少。在广泛推荐7.0 g/dl的输血触发值之前，需要进行前瞻性研究。
An acceptable strategy for transfusion of burn patients has not been specifically identified. In 1999, we empirically adopted a hemoglobin (Hb) transfusion trigger of 7.0 g/dl or greater in our burn center. The purpose of this study was to evaluate the effects of this restrictive transfusion strategy. Retrospective comparison of adults with 20% or greater TBSA treated from 1999 to 2004 (restrictive group; REST) with patients treated before our adoption of the restrictive transfusion strategy (1997-1998: liberal group; LIB). The REST group (n = 135, age 42 +/- 17 years, %TBSA burn 37 +/- 14, and 26% incidence of inhalation injury) did not differ significantly from the LIB group (n = 37, age 42 +/- 16 years, %TBSA burn 38 +/- 17, and 35% inhalation injury). The Hb triggering a transfusion was 7.1 +/- 1.2 g/dl in the REST group, compared with 9.2 +/- 2.1 g/dl in the LIB group (P < .001). The REST group received significantly fewer units of blood per day than the LIB Group. Patients in the REST group appeared to have significantly better organ function, and there were no differences between the groups in the incidence of acute myocardial infarction. Mortality at 30 days was significantly lower in the REST group (19% vs 38%; P = .03), as was overall in-hospital mortality (22% vs 46%; P = .003). Transfusion restriction appears to be safe and resulted in fewer transfusions among this group of burn patients. Prospective studies are needed before broadly recommending a transfusion trigger of 7.0 g/dl.