多国研究人员共同合作,对感染性休克患者进行输血的血红蛋白不同指征阈值进行对比,发现HG7g/L进行输血与HG9g/L相比,两组病人的90天死亡率、缺血事件发生率和使用生命支持的人数均相似;而且HG7g/L组病人接受的输血更少。

2014109日《新英格兰医学杂志》

中文翻译


 

【题目】感染性休克患者输血的血红蛋白低阈值与高阈值的对比

【译文】

背景:输血是治疗感染性休克的常用方法。但是,对于是否输血,不同的血红蛋白(HG)指征阈值带来的利弊尚未可知。

方法:我们进行了一项多中心的平行组试验,将重症监护病房(ICU)的感染性休克病人进行随机分配,在ICU期间,HG浓度低于9g/L输入1个单位去白细胞的红细胞,HG低于7g/L作为输血指征的低阈值,HG低于9g/L作为高阈值。主要观察结果是随机分组后90天的死亡率。

结果:我们分析了被随机分配的1105个病人中的998(99.3%)的数据。两组病人的基本特性相似。在ICU,低阈值组输入血液的中位数为1个单位(四分位数间距:0-3),高阈值组输入血液的中位数为4个单位(四分位数间距:2-7)。随机分配后90天,低阈值组的502个病人中有216(43.0%)人死亡,高阈值组的496个病人中有223(45.0%)死亡(相对危险度0.9495%可信区间0.78-1.09P=0.44)。本结果与校正了基本资料中危险因素后的分析结果相似,也与对试验前的人群进行分析的结果相似。两组病人中发生缺血事件、发生严重副作用和需要生命支持的人数均相似。

结论:发生感染性休克的病人,随机分配进入输血指征为高HG阈值和低HG阈值两组,两组病人的90天死亡率、缺血事件发生率和使用生命支持的人数均相似;低阈值组接受的输血更少。

 

英文原稿


 

[Title] Lower versus Higher Hemoglobin Threshold for Transfusion in Septic Shock

[Authors] Holst LB, Haase N, Wetterslev J, Wernerman J, Guttormsen AB, Karlsson S, et al.

[Abstract]

BACKGROUND: Blood transfusions are frequently given to patients with septic shock. However, the
benefits and harms of different hemoglobin thresholds for transfusion have not been established.

METHODS: In this multicenter, parallel-group trial, we randomly assigned patients in the intensive care
unit (ICU) who had septic shock and a hemoglobin concentration of 9 g per deciliter or less to receive
1 unit of leukoreduced red cells when the hemoglobin level was 7 g per deciliter or less (lower threshold)
or when the level was 9 g per deciliter or less (higher threshold) during the ICU stay. The primary
outcome measure was death by 90 days after randomization.

RESULTS: We analyzed data from 998 of 1005 patients (99.3%) who underwent randomization. The
two intervention groups had similar baseline characteristics. In the ICU, the lower-threshold group
received a median of 1 unit of blood (interquartile range, 0 to 3) and the higher-threshold group received
a median of 4 units (interquartile range, 2 to 7). At 90 days after randomization, 216 of 502 patients
(43.0%) assigned to the lower-threshold group, as compared with 223 of 496 (45.0%) assigned to the
higher-threshold group, had died (relative risk, 0.94; 95% confidence interval, 0.78 to 1.09; P=0.44).

The results were similar in analyses adjusted for risk factors at baseline and in analyses of the per-
protocol populations. The numbers of patients who had ischemic events, who had severe adverse
reactions, and who required life support were similar in the two intervention groups.

CONCLUSIONS: Among patients with septic shock, mortality at 90 days and rates of ischemic
events and use of life support were similar among those assigned to blood transfusion at a higher
hemoglobin threshold and those assigned to blood transfusion at a lower threshold; the latter
group received fewer transfusions.

 

原文地址:

http://www.nejm.org/doi/full/10.1056/NEJMoa1406617?query=featured_home

 

 

本站声明: 生物文库所有文章欢迎转载,所有文章未说明,均属于原创,转载均请注明出处。
本文链接: http://www.bioku.cn/201410/new-england-journal-of-medicine-2014-10-9/
版权所有: 生物文库 - 生物医学、生物技术核心期刊文摘

留言


× 9 = 六十 三


沪ICP备12028140号
点击这里给我发消息   点击这里给我发消息