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【文摘发布】儿科重症监护室患者的输血策略
RESOURCE: NEJM.Volume 356:1609-1619 April 19, 2007 Number 16
TITLE: Transfusion Strategies for Patients in Pediatric Intensive Care Units
AUTHOR: Jacques Lacroix, M.D., Paul C. Hébert, M.D., James S. Hutchison, M.D., Heather A. Hume, M.D., Marisa Tucci, M.D., Thierry Ducruet, M.Sc., France Gauvin, M.D., Jean-Paul Collet, M.D., Ph.D., Baruch J. Toledano, M.D., Pierre Robillard, M.D., Ari Joffe, M.D., Dominique Biarent, M.D., Kathleen Meert, M.D., Mark J. Peters, M.D., for the TRIPICU Investigators, the Canadian Critical Care Trials Group, and the Pediatric Acute Lung Injury and Sepsis Investigators Network
ABSTRACT
Background The optimal hemoglobin threshold for erythrocyte transfusions in critically ill children is unknown. We hypothesized that a restrictive transfusion strategy of using packed red cells that were leukocyte-reduced before storage would be as safe as a liberal transfusion strategy, as judged by the outcome of multiple-organ dysfunction.
Methods In this noninferiority trial, we enrolled 637 stable, critically ill children who had hemoglobin concentrations below 9.5 g per deciliter within 7 days after admission to an intensive care unit. We randomly assigned 320 patients to a hemoglobin threshold of 7 g per deciliter for red-cell transfusion (restrictive-strategy group) and 317 patients to a threshold of 9.5 g per deciliter (liberal-strategy group).
Results Hemoglobin concentrations were maintained at a mean (±SD) level that was 2.1±0.2 g per deciliter lower in the restrictive-strategy group than in the liberal-strategy group (lowest average levels, 8.7±0.4 and 10.8±0.5 g per deciliter, respectively; P<0.001). Patients in the restrictive-strategy group received 44% fewer transfusions; 174 patients (54%) in that group did not receive any transfusions, as compared with 7 patients (2%) in the liberal-strategy group (P<0.001). New or progressive multiple-organ dysfunction syndrome (the primary outcome) developed in 38 patients in the restrictive-strategy group, as compared with 39 in the liberal-strategy group (12% in both groups) (absolute risk reduction with the restrictive strategy, 0.4%; 95% confidence interval, –4.6 to 5.4). There were 14 deaths in each group within 28 days after randomization. No significant differences were found in other outcomes, including adverse events.
Conclusions In stable, critically ill children a hemoglobin threshold of 7 g per deciliter for red-cell transfusion can decrease transfusion requirements without increasing adverse outcomes. (Controlled-trials.com number, 本人认领此文. 如在48小时内未能提交译文, 其他战友可自由认领. 编译后：216字
儿科ICU输血策略
儿科ICU有更佳的血红蛋白输血阈值。来自加拿大重症特别护理小组、儿科急性肺损伤和败血症调查网的Lacroix等研究人员采用随机、对照、分组方法研究了637例的的儿科ICU病情稳定的病危儿童，其中限制输血组320例（入选标准：血红蛋白值阈值为70g/l），自由输血组317例（入选标准：血红蛋白值为9.5g/dl）。结果表明，限制输血组在减少输血量、维持血红蛋白浓度等方面优于自由输血组，而在死亡率、病情恶化、甚至副反应等方面没有显著差异。研究者认为，儿科ICU中病危患儿采用血红蛋白量阈值为7g/dl的进行限制输血能在不增加不良作用的情况下达到更好的效果，是一种更佳的血红蛋白阈值。 我将LINK上了，请核对，谢谢。
1、这篇文章不是讨论“ 输全血 和 成分输血
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作者:admin@医学,生命科学 2010-11-13 05:11
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