心脏手术中的自体血逆预充：一项系统回顾和Meta分析

2021

05/17

米勒之声

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心脏手术中的自体血逆预充：一项系统回顾和Meta分析

贵州医科大学高鸿教授课题组

翻译：潘志军 编辑：佟睿审校：曹莹

背景

在体外循环（CPB）之前进行自体血逆预充（RAP）可以最大程度地减少异体血红细胞的输注。我们对文献进行了系统回顾，以检验RAP对心脏外科手术患者围手术期异体红细胞输注的影响。

方法

本研究对评价RAP在CPB心脏手术中应用的随机对照试验(RCTs)和观察性研究进行了系统回顾和Meta分析。主要观察指标是术中同种异体红细胞输血。次要观察指标包括全院同种异体输血和不良事件，例如急性肾损伤（AKI）和卒中。

结果

本研究共包括11个RCT（n = 1337例患者），将RAP患者（n = 674）与对照组（n = 663）进行了比较。此外，还包括10项观察性研究（n = 2327），将RAP患者（n = 1257）与对照组（n = 1070）进行了比较。总体而言，与对照组相比，RAP与术中红细胞输注（n = 18个研究；优势比[OR] = 0.34；95％置信区间[CI]，0.22-0.55，P <0.001）发生率显着降低有关。在随机对照试验（n = 10个研究；OR = 0.19；95％CI，0.08–0.45，P <0.001）和观察性研究（n = 8个研究；OR = 0.66；95％CI，0.50–0.87, P = .004）中单独观察到了这种效果。RAP还与全院红细胞输血的发生率显着降低有关（n = 5个研究；OR = 0.28；95％CI，0.19-0.41，P <0.001）。在报告AKI和卒中预后的研究中，RAP和对照患者中AKI或卒中的几率均无统计学显着增加。

结论

根据现有文献的汇总结果，RAP与术中和整个医院的异体红细胞输血显著减少有关。并且，使用RAP可以防止心脏外科手术患者的血液稀释，从而减少输血。但还需要其它的高质量前瞻性研究来确定理想的预充量，以在不损伤器官的情况下为患者提供最大的益处。

原始文献来源：

Nadia B. Hensley, Richard Gyi,Andres Zorrilla-Vaca, et al. Retrograde Autologous Priming in Cardiac Surgery: Results From a Systematic Review and Meta-analysis.[J].Anesth Analg 2021;132:100–7.

Retrograde Autologous Priming in Cardiac Surgery: Results From a Systematic Review and Meta-analysis

Abstract

Background: Retrograde autologous priming (RAP) before cardiopulmonary bypass (CPB) may minimize allogeneic red cell transfusion. We conducted a systematic review of the literature to examine the impact of RAP on perioperative allogeneic red cell transfusions in cardiac surgical patients.

Methods: This study involved a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies evaluating the use of RAP in cardiac surgery involving CPB. The primary outcome was intraoperative allogeneic red cell transfusion. Secondary outcomes included whole hospital allogeneic transfusions and adverse events such as acute kidney injury (AKI) and stroke.

Results: A total of 11 RCTs (n = 1337 patients) were included, comparing RAP patients (n = 674) to control (n = 663). In addition, 10 observational studies (n = 2327) were included, comparing RAP patients (n = 1257) to control (n = 1070). Overall, RAP was associated with a significantly reduced incidence of intraoperative red cell transfusion (n = 18 studies; odds ratio [OR] = 0.34; 95% confidence interval [CI], 0.22–0.55, P < .001) compared to controls. This effect was seen among RCTs (n = 10 studies; OR = 0.19; 95% CI, 0.08–0.45, P < .001) and observational studies (n = 8 studies; OR = 0.66; 95% CI, 0.50–0.87, P = .004) in isolation. RAP was also associated with a significantly reduced incidence of whole hospital red cell transfusion (n = 5 studies; OR = 0.28; 95% CI, 0.19–0.41, P < .001). Among the studies that reported AKI and stroke outcomes, there was no statistically significant increased odds of AKI or stroke in either RAP or control patients.

Conclusions: Based on the pooled results of the available literature, RAP is associated with a significant reduction in intraoperative and whole hospital allogeneic red cell transfusion. Use of RAP may prevent hemodilution of cardiac surgical patients and thus, lessen transfusions. Additional high-quality prospective studies are necessary to determine the ideal priming volume necessary to confer the greatest benefit without incurring organ injury.