术前使用促红细胞生成素对手术患者输血率的影响

Impact of Preoperative Erythropoietin on Allogeneic Blood Transfusions in Surgical Patients: Results From a Systematic Review and Meta-analysis

背景与目的

促红细胞生成素（EPO）等促进红细胞生成的药物已被用作患者血液管理计划的一部分，以减少甚至避免异体输血。我们回顾了相关文献来评估术前使用促红细胞生成素对围术期异体输血风险的影响。

方  法

本次研究涉及一系列评估术前促红细胞生成素使用的系统回顾和Meta分析。主要评估指标是异体输血在患者住院期间的发生率。次要指标包括异体输血(即术中、术后)、术中估计失血量、围术期血红蛋白水平、住院时间和血栓栓塞并发症发生率。

结 果  

32项研究(n=4750名患者)被纳入最终分析，将术前使用EPO的患者(n=2482)与对照组(n=2268)进行比较。心脏手术和骨科手术患者术前使用促红细胞生成素与异体输血的发生率显著降低相关。与对照组相比，术前应用EPO可显著减少术中、术后和护理阶段的异体输血发生率。但组间血栓栓塞并发症发生率无明显差异。

结 论

术前使用促红细胞生成素可显著减少围术期异体输血发生率。此外，我们的研究表明，术前使用促红细胞生成素不会增加血栓栓塞并发症的发生风险。

原始文献摘要

Brian C. Cho, MD, Jessica Serini, MD,Andres Zorrilla-Vaca, et al. Impact of Preoperative Erythropoietin on Allogeneic Blood Transfusions in Surgical Patients: Results From a Systematic Review and Meta-analysis. Anesthesia-Analgesia, 2019,128, 981-992.

BACKGROUND: Erythropoietic-stimulating agents such as erythropoietin have been used as part of patient blood management programs to reduce or even avoid the use of allogeneic blood transfusions. We review the literature to evaluate the effect of preoperative erythropoietin use on the risk of exposure to perioperative allogeneic blood transfusions. METHODS: The study involved a systematic review and meta-analysis of randomized controlled trials evaluating the use of preoperative erythropoietin. The primary outcome was the reported incidence of allogeneic red blood cell transfusions during inpatient hospitalizations. Secondary outcomes included phase-specific allogeneic red blood cell transfusions (ie, intraoperative, postoperative), intraoperative estimated blood loss, perioperative hemoglobin levels, length of stay, and thromboembolic events. RESULTS: A total of 32 randomized controlled trials (n = 4750 patients) were included, comparing preoperative erythropoietin (n = 2482 patients) to placebo (n = 2268 patients). Preoperativeerythropoietin is associated with a significant decrease in incidence of allogeneic blood transfusions among all patients (n = 28 studies; risk ratio, 0.59; 95% CI, 0.47–0.73; P < .001) as well as patients undergoing cardiac (n = 9 studies; risk ratio, 0.55; 95% CI, 0.37–0.81; P = .003) and elective orthopedic (n = 5 studies; risk ratio, 0.36; 95% CI, 0.28–0.46; P < .001) surgery compared to placebo, respectively. Preoperative erythropoietin was also associated with fewer phase-specific red blood cell transfusions. There was no difference between groups in incidence of thromboembolic events (n = 28 studies; risk ratio, 1.02; 95% CI, 0.78–1.33; P = .68). CONCLUSIONS: Preoperative erythropoietin is associated with a significant reduction in perioperative allogeneic blood transfusions. This finding is also confirmed among the subset of patients undergoing cardiac and orthopedic surgery. Furthermore, our study demonstrates no significant increase in risk of thromboembolic complications with preoperative erythropoietin administration. 

（原标题：术前使用促红细胞生成素对手术患者输血率的影响：系统回顾和Meta分析）