不同输血策略对贫血的极低出生体重儿治疗转归的影响

Comparison of clinical outcomes in very low birth weight infants with anemia by different transfusion strategies

摘要:

目的：观察限制性输血、非限制性输血两种不同输血策略对极低出生体重儿的病情及预后的影响，为制定输血策略、合理输血提供依据。方法：首次入住我院NICU，住院期间接受输血治疗的93例早产极低出生体重儿资料进行回顾性分析。其中35例接受限制性输血，58例接受非限制性输血。结果：①限制性输血组输血次数比非限制性输血组多（2.6±1.8 vs 1.8±1.0, P<0.05），且机械辅助通气天数比非限制性输血组明显增多（8.0±5.9 d vs 5.5±4.2 d， P<0.05）。②非限制性输血的患儿恢复至出生体重所需时间比限制性输血患儿少(中位数：10 d vs 13 d，P<0.01)。③两组患儿呼吸暂停及院内感染的发生率差异无显著性。结论：非限制性输血可能更利于临床恢复，部分患儿因保守输血而出现的临床并发症使得输血次数或输血量增多。在输血策略上，不要一味追求保守输血策略，要权衡利弊，科学合理用血。［中国当代儿科杂志，2010，12（1）：9-12］

Abstract:

OBJECTIVE: To evaluate the risks and benefits of two transfusion strategies (liberal-transfusion and restrictive-transfusion), as judged by the clinical progress and outcome, in very low birth weight infants. METHODS: The clinical data of 93 hospitalized very low birth weight infants who required blood transfusions were retrospectively studied. The infants were assigned to either the liberal transfusion group (n=58), with higher hematocrit levels, or the restrictive-transfusion group (n=35), with lower hematocrit levels. RESULTS: The infants in the restrictive-transfusion group received more numbers of RBC transfusions compared with the liberal-transfusion group (2.6±1.8 vs 1.8±1.0; P<0.05). Liberal-transfusion was associated with faster weight gain and the duration to return to the birth weight averaged 10 days in the liberal-transfusion group compared with 13 days in the restrictive-transfusion group (P<0.01). The infants in the liberal-transfusion group had shorter duration of mechanical ventilation than in the restrictive-transfusion group (5.5±4.2 days vs 8.0± 5.9 days; P<0.05). There were no significant differences in the incidence of apnea and nosocomial infections between two groups. CONCLUSIONS: The study suggests the possible benefits from liberal-transfusion for clinical recovery in very low birth weight infants. The restrictive transfusion does not decrease the number of transfusions. It in fact increases the number of clinical indicated transfusions. Neonatologists should weigh the advantages and disadvantages on transfusions to make the optimal decision.［Chin J Contemp Pediatr, 2010, 12 (1):9-12］