不同输血策略对上消化道出血患者预后的分析研究

Different blood transfusion strategies on the prognosis of patients with upper gastrointestinal bleeding

目的比较限制性与开放性输血策略对消化道出血患者治疗的预后效果。方法检索中英文数据库Pubmed、Web Of Science、Embase、Cochrance library、Ovid、知网、万方、中国生物医学文献数据库1990年1月1日至2022年12月31日收录文献,筛选符合主题的临床随机对照试验,进行Cochrane偏倚风险评价,对结局指标绘制森林图,评价各结局指标差异。结果纳入9篇文献,共2549例患者,结局中死亡率、再出血率、止血率、肺部并发症、细菌感染、发热、总不良反应发生率的RR(95%CI)分别为:0.68(0.48~0.97)、0.56(0.44~0.71)、3.00(1.73~5.21)、0.47(0.26~0.85)、0.95(0.81~1.12)、0.47(0.20~1.10)、0.36(0.23~0.57)。限制性组低于开放性组;止血率限制性组明显高于开放性组;细菌感染与发热结局指标组间差异无统计学意义。结论不同输血策略对患者死亡率、再出血率、肺部并发症、总不良反应率均存在影响。

Objective To compare the prognostic effects of restrictive and open blood transfusion strategies in the treatment of patients with gastrointestinal bleeding.Methods The Pubmed,Web Of Science,Embase,Cochrance library,Ovid,CNKI,Wanfang,and China Biomedical Literature Database were searched for literature from 1990 to 2022,and clinical randomization that matches the theme were screened.Cochrane risk of bias evaluations were performed,and forest plots were drawn for outcome indicators to evaluate differences among outcome indicators.Results Nine publications with a total of 2549 patients were included.Among the outcomes,the RR(95%CI)of mortality,re-bleeding rate,hemostasis rate,pulmonary complication,bacterial infection,fever,and overall adverse reaction rate in the outcome were 0.68(0.48-0.97),0.56(0.44-0.71),3.00(1.73-5.21),0.47(0.26-0.85),0.95(0.81-1.12),0.47(0.20-1.10),0.36(0.23-0.57).There were differences in mortality,rebleeding rate,pulmonary complication,and overall adverse reaction rate outcome indicators,with the restrictive group being lower than the open group;the hemostasis rate in the restrictive group being significantly higher than in the open group;no statistical association in bacterial infection and fever outcome indicators between the groups.Conclusion Different blood transfusion strategies have an impact on patient mortality,re-bleeding rate,pulmonary complications,and total adverse reaction rate.