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红细胞输注:美国血库协会(AABB)临床实践指南

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说明:尽管全球每年有将近8500万单位红细胞用于血液输注,但其具体输注操作却大相径庭。AABB(美国血库协会)制定了本指南,以便为临床上血流动力学稳定的成人与儿童的输血提供建议,包括血红蛋白浓度的临界值及其他需要红细胞输注的临床情况。

研究方法:本指南以一项对文献的系统综述为基础编制,所考查文献涉及一系列评估输血参数阈值的随机临床试验。文献搜索自1950年至2011年2月,无语种限制。调查所有接受过红细胞输注的患者比例以及所使用红细胞单位数,以便呈现限制性使用红细胞输注策略的效果。为进一步确定限制性输注策略的临床结局,调查研究如下与红细胞输注策略相关的事件:总死亡率、非致死性心肌梗死、心血管事件、肺水肿、中风、血栓栓塞、肾衰竭、感染、出血、神智混乱、功能恢复、住院时长。

推荐1:对于情况稳定的住院患者,应严格限制输血(7-8g/dl以下方考虑输血)。(推荐程度:极力推荐;高质量证据。)

对于ICU的成人或儿童患者,在患者Hb≤7g/dl时考虑输血。对于术后患者,出现症状(胸痛、体位性低血压、补液不能纠正的心动过速、充血性心衰)或Hb≤8g/L时考虑输血。

推荐2:对于患有心血管疾病的住院患者,当其有症状(胸痛、体位性低血压、补液不能纠正的心动过速、充血性心衰)或Hb≤8g/L时可考虑输血。(推荐程度:弱;中等质量证据。)

推荐3:对于患有急性冠脉综合征且血流动力学稳定的住院患者,持中立态度。(推荐程度:不确定;极低质量证据。)

推荐4:输血决策应取决于患者症状与血红蛋白浓度两方面因素。(推荐程度:弱;低质量证据。)





北大医学院 周天池翻译 北京协和医院 李莎审核
英文原标题:
Red Blood Cell Transfusion: A Clinical Practice Guideline From the AABB
Description: Although approximately 85 million units of red blood cells (RBCs) are transfused annually worldwide, transfusion practices vary widely. The AABB (formerly, the American Association of Blood Banks) developed this guideline to provide clinical recommendations about hemoglobin concentration thresholds and other clinical variables that trigger RBC transfusions in hemodynamically stable adults and children.







Methods: These guidelines are based on a systematic review of the literature on randomized clinical trials evaluating transfusion thresholds. We performed a literature search from 1950 to February 2011 with no language restrictions. We examined the proportion of patients who received any RBC transfusion and the number of RBC units transfused to describe the effect of restrictive transfusion strategies on RBC use.




To determine the clinical consequences of restrictive transfusion strategies, we examined overall mortality, nonfatal myocardial infarction, cardiac events, pulmonary edema, stroke, thromboembolism, renal failure, infection, hemorrhage, mental confusion, functional recovery, and length of hospital stay.




Recommendation 1: The AABB recommends adhering to a restrictive transfusion strategy (7 to 8 g/dL) in hospitalized, stable patients (Grade: strong recommendation; high-quality evidence).







In adult and pediatric intensive care unit patients, transfusion should be considered at hemoglobin concentrations of 7 g/dL or less.




In postoperative surgical patients, transfusion should be considered at a hemoglobin concentration of 8 g/dL or less or for symptoms (chest pain, orthostatic hypotension or tachycardia unresponsive to fluid resuscitation, or congestive heart failure).







Recommendation 2: The AABB suggests adhering to a restrictive strategy in hospitalized patients with preexisting cardiovascular disease and considering transfusion for patients with symptoms or a hemoglobin level of 8 g/dL or less (Grade: weak recommendation; moderate-quality evidence).




Transfusion should be considered at a hemoglobin concentration of 8 g/dL or less or for symptoms (chest pain, orthostatic hypotension or tachycardia unresponsive to fluid resuscitation, or congestive heart failure).




Recommendation 3: The AABB cannot recommend for or against a liberal or restrictive transfusion threshold for hospitalized, hemodynamically stable patients with the acute coronary syndrome (Grade: uncertain recommendation; very low-quality evidence).




Recommendation 4: The AABB suggests that transfusion decisions be influenced by symptoms as well as hemoglobin concentration (Grade: weak recommendation; low-quality evidence).
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