老年髋部骨折患者术后输血策略比较

A Comparison of Postoperative Transfusion Strategies in Elderly Patients with Hip Fracture

目的老年患者髋部骨折可能造成患者残疾甚至死亡,这类患者经常出现术后失血,而红细胞输注量尚不清楚。本研究探讨红细胞输注量与髋部骨折术后身体恢复程度或死亡率的关系。方法纳入本院住院115例年龄大于65岁且Hb<113 g/L的髋部骨折术后患者,将患者随机分为两组即限制性输血策略组(Hb<97 g/L)或开放式输血策略组(Hb<113 g/L),在术后30d内给予红细胞输注,随访时间为90d。结果重复测量两组受试者日常活动情况或90d内死亡率,限制性输血策略组(30%死亡)和开放式输血策略组(16%死亡)的差异无统计学意义。相比限制性输血策略组而言,开放式输血策略组30 d的死亡率较高[风险比(HR)=1.7 95%CI 0.6-3.4; P=0.02]。结论根据Hb阈值,限制性输血策略和开放式输血策略在体弱的老年髋部骨折患者恢复相比差异有统计学意义,且开放式输血策略有提高生存率的潜力。

Objective Hip fracture (HF) in frail elderly patients is associated with poor physical recovery and death. Postoperative blood loss is frequently seen and the volume of red blood cell (RBC) transfusions is unknown in the patients. Method We investigated the association of RBC transfusion strategies with the degree of physical recovery or with reduced mortality after HF surgery. We collected 115 consecutive postsurgical HF patients (age≥65 years) with Hb levels<113 g/L in the hospital. Allocation was stratified by residence. The patients were randomLy assigned to either restrictive (Hb<97g/L) or liberal (Hb<113g/L) RBC transfusions given within the first 30 days postoperatively. Followup was performed for 90 days. Results Statistically significant differences were found in repeated measures of daily living activities or in 90-day mortality rate between the restrictive group (30% died) and the liberal group (16% died). Thirtyday mortality was higher with the restrictive strategy (hazard ratio (HR)=1.795%CI 0.6-3.4;P =0.02) compared with that with liberal transfusion. The 90-day mortality rate was higher for patients in the restrictive transfusion group (36%) than for those in the liberal group (20%)(HR =1.595%CI 0.8 -2.1;P =0.03). Conclusion According to our Hb thresholds,recovery from physical disabilities in the patients with frail elderly hip fracture varied following restrictive RBC transfusion strategy and liberal strategy. Implementation of a liberal RBC transfusion strategy in nursing home residents has the potential in increasing survival.