输注血液制品与心脏术后结局相关性的系统分析

Correlation Between Blood Transfusion and Postoperative Outcomes following Cardiac Surgery: A Systematic Review

目的 系统评价心脏围术期输血与术后近远期结局的关系。方法 检索中英文文献数据库中1990年1月至2014年12月关于输血和心脏术后结局关系的回顾性病例对照研究,使用Rev Man 5.3软件,应用Meta分析方法对所纳入文献的研究结果进行定量综合分析。结果 本研究共纳入13项回顾性病例对照临床研究,总样本量88 808例,其中输血组42 991例,未输血组45 817例。输血组和未输血组的各心脏术后结局指标差异均有统计学意义：30 d死亡率（OR=2.39,95%CI：1.71-3.34,P〈0.000 01）,1年死亡率（OR=3.08,95%CI：2.18-4.35,P〈0.000 01）,5年死亡率（OR=1.90,95%CI：1.42-2.56,P〈0.0001）,缺血事件（OR=2.23,95%CI：1.71-2.90,P〈0.000 01）,感染（OR=2.18,95%CI：1.74-2.75,P〈0.000 01）。结论 围术期输血与心脏手术后近远期死亡率和缺血事件、感染的发生具有明显相关性。

Objective To systematically assess the correlation between blood transfusion and postoperative outcomes following cardiac surgery .Methods Databases were searched for retrospective case-control studies on blood transfusion and postoperative outcome after cardiac surgery published in Chinese and English between January 1990 and December 2014 .A meta-analysis was performed using RevMan 5.3 for quantitative synthesis of findings from included studies .Results Thirteen retrospective case-control studies including 88 808 patients （42 991 blood transfusion cases , 45 817 non-transfusion cases ） were eligible for inclusion .The pooled analysis revealed statistically significant differences in all the postoperative outcomes ：30-day mortality （ OR=2.39 , 95%CI：1.71-3.34 , P〈0.000 01 ） , 1-year mortality （ OR =3.08 , 95% CI： 2.18 -4.35 , P〈0.000 01 ） , 5-year mortality （ OR=1.90 , 95%CI：1.42-2.56 , P〈0.0001 ） , ischemic accident （ OR=2.23 , 95%CI：1.71-2.90 , P〈0.000 01 ） , and infection （ OR=2.18 , 95%CI：1.74-2.75 , P〈0.000 01 ） .Conclusion Perioperative blood transfusion may be strongly related with the risk of postoperative short -and long-term mortality, ischemic events , and infection following cardiac surgery .