背景:贫血是动脉瘤性蛛网膜下腔出血的常见并发症,并与不良预后相关。输血对贫血的生理益处是否超过输血的风险尚待确定。
目的:主要结局是评估围手术期输血对长期神经系统结局的影响,在3个月时通过格拉斯哥结果量表进行评估。次要结局包括输血对短期神经系统结局的影响,通过出院时修改的Rankin评分/7天评估,关于血管痉挛的发生率,梗塞,重新探索,气管造口术,和住院时间。
方法:这项前瞻性观察性研究是对185例动脉瘤性蛛网膜下腔出血患者进行动脉瘤颈夹闭术。在我们的研究中,输血以保持目标Hb在10g/dL左右。
结果:在接受输血的患者中有27/97(28%)发现不利的长期结局,而未接受输血的患者中有13/74(18%)(P=0.116)。与未输血的患者相比,接受输血的患者在出院/7天有更多的机会出现不利结果[44/103(43%)与22/80(27%)]。P=0.025。血管痉挛的几率增加了,梗塞,重新探索,气管造口术,输血患者住院时间增加(P<0.05)。
结论:动脉瘤性蛛网膜下腔出血患者使用输血与神经系统并发症增加相关,因此短期预后不利。然而,当根据临床要求审慎使用时,输血对长期神经系统预后没有显著影响.
BACKGROUND: Anemia is a common complication of aneurysmal subarachnoid hemorrhage and is associated with unfavorable outcomes. Whether the physiological benefits of transfusion for anemia surpass the risk of blood transfusion remains to be determined.
OBJECTIVE: The primary outcome was to evaluate the impact of peri-operative blood transfusion on the long-term neurological outcome, assessed by Glasgow Outcome Scale Extended at 3 months. The secondary outcomes included the impact of transfusion on the short-term neurological outcome, assessed by Modified Rankin Score at discharge/7 days, and on the incidence of vasospasm,
infarction, re-exploration, tracheostomy, and length of hospital stay.
METHODS: This prospective observational
study was conducted on 185 patients with aneurysmal subarachnoid hemorrhage undergoing clipping of the aneurysmal neck. In our
study, blood transfusion was administered to keep the target Hb around 10 g/dL.
RESULTS: Unfavorable long-term outcome was found in 27/97 (28%) of patients who received a blood transfusion as compared to 13/74 (18%) of patients who did not receive a transfusion (P = 0.116). Patients receiving transfusion had more chances of an unfavorable outcome at discharge/7 days as compared to those not transfused [44/103 (43%) versus 22/80 (27%)], P = 0.025. There were increased chances of vasospasm,
infarction, re-exploration, tracheostomy, and increased length of hospital stay in patients receiving transfusion (P < 0.05).
CONCLUSIONS: The use of blood transfusion in patients with aneurysmal subarachnoid hemorrhage was associated with increased neurological complications and hence an unfavorable short-term outcome. However, when used judiciously as per the clinical requirements, blood transfusion did not have a significant effect on long-term neurological outcome.