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目的比较采取限制性与自由输血策略的心血管疾病患者的非心脏手术结局。数据来源搜集涉及医院红细胞输注阈值的随机控制试验。检索CENTRAL、Medline、EMBase、CINAHL、PubMed、LILACS、NHSBT输血证据库、Clinical Trials.gov、WHO国际临床试验注册平台、国际标准随机对照临床试验编号登记、欧盟临床试验登记。检索时间为2015-11-02之前。试验选择选取发表与未发表的比较限制性与自由输血阈值的随机控制试验,试验均纳入心血管疾病患者。结果检索到41项试验,其中7项试验纳入心血管疾病患者。另选取4项纳入心血管疾病患者的试验。最终共搜集11项纳入心血管疾病患者(n=3 033)的试验进行Meta分析(限制性输血1 514例,自由输血1 519例)。输血阈值与30 d死亡率之间联系的汇集风险比例为1.15〔95%CI(0.88,1.50),P=0.50〕,异质性较小(I~2=14%)。限制性输血患者的急性冠脉综合征风险与自由输血患者相比更高〔9项试验;风险比例1.78,95%CI(1.18,2.70),P=0.01,I~2=0%〕。结论对急性冠脉综合征或慢性心血管疾病患者采取80 g/L以下的限制性输血阈值可能并不安全,对病死率与其他结局的影响并不确定。这些数据可暂时支持对急性或慢性心血管疾病患者使用更加自由的输血阈值(>80 g/L),但有待更具有说服力的高质量的心血管疾病患者随机试验进行验证。
Objective To compare the outcome of non-cardiac surgery in patients with cardiovascular disease who are using restrictive and free transfusion strategies. Data sources Collect randomized controlled trials involving the threshold of hospital red blood cell transfusion. Retrieval of CENTRAL, Medline, EMBase, CINAHL, PubMed, LILACS, NHSBT Blood Transfusion Database, Clinical Trials.gov, WHO International Clinical Trial Registry, International Standard Randomized Controlled Clinical Trials Register, EU Clinical Trials Register. Retrieved 2015-11-02 before. The trial selected published and unpublished comparative and free transfusion thresholds of randomized controlled trials, trials were included in patients with cardiovascular disease. Results 41 trials were retrieved, of which 7 trials were included in patients with cardiovascular disease. Another four trials were included in patients with cardiovascular disease. A total of 11 trials involving patients with cardiovascular disease (n = 3 033) were finally collected for meta-analysis (15 514 cases of restricted transfusion and 1519 cases of free transfusion). The pooled risk ratio was 1.15 (95% CI (0.88, 1.50), P = 0.50) and less heterogeneity (1-2%) for the association between the threshold of transfusion and the 30-day mortality. Patients with restricted transfusions had a higher risk of acute coronary syndrome than patients with free transfusions (9 trials; risk ratio 1.78, 95% CI 1.18, 2.70, P 0.01, I 2 = 0%). Conclusion It may not be safe to use a restricted blood transfusion threshold of 80 g / L or lower for patients with acute coronary syndrome or chronic cardiovascular disease. The impact on mortality and other outcomes is uncertain. These data may temporarily support the use of more liberal transfusion thresholds (> 80 g / L) in patients with acute or chronic cardiovascular disease, but are expected to be more convincing in randomized trials of patients with high-quality cardiovascular disease.