ABSTRACT
Objective Using meta-analysis method to compare the effect of liberal and restrictive transfusion strategies on the prognosis of adult patients undergoing cardiac surgery,and to provide evidence for evidence-based medicine.Methods By using the Cochrane system evaluation method,the database of Chinese and foreign countries,Chinese biomedical literature database,Chinese journal full-text database and so on were searched by computer.To search the literature from 1970 to 2018,and to collect clinical randomized controlled trials on blood transfusion strategy and prognosis in adult patients undergoing cardiac surgery.According to the evaluation method of Cochrane system,the effective data extracted is analyzed by meta with RevMan5.3 software.Results A total of 2 863 patients were included in 9 studies.Meta-analysis results showed that the death toll on 30 days after operation (RR value:1.02,95 ％ CI:0.79-1.32,I2 =2％,P =0.86),acute renal damage,infection,acute renal injury,pulmonary complications and hospital stay time were no statistical difference,but ICU retention time(RR value:-33.35,95％ CI:-61.7-1.01,I2 =38％,P =0.04) in the restrictive transfusion policy group was significantly lower than that of liberal blood transfusion strategy group.Conclusion The use of liberal or restrictive blood transfusion strategy in adult cardiac surgery has no significant impact on the prognosis and complications,but it can reduce the retention time of ICU after operation and significantly reduce the use of blood products and medical costs.
ABSTRACT
Objective:To compare the clinical effects of restrictive blood transfusion combined with hyperbaric oxygen preconditioning (HBOPC) and restrictive blood transfusion in the treatment of hip,knee arthroplasty (THA,THA).Methods:40 patients in the period of epidural anesthesia,femoral nerve hysteresis hip and knee arthroplasty were selected and randomly divided into two groups:restrictive transfusion group (maintain 80 g/L≤ Hb ＜100 g/L,n=20) and restrictive blood transfusion combined with HBOPC (HBOPC+maintain 80 g/L =Hb ＜100 g/L,n=20).The red blood cell transfusion,red blood cell transfusion rate,perioperative Hb,blood oxygen saturation (SO2),the incidence of hypotension during operation,hospitalization time and postoperative cerebral infarction,acute pulmonary embolism,pneumonia,myocardial infarction,wound infection rate and 90 days mortality rate were compared between two groups.Results:Compared with the restrictive transfusion group,the postoperative Hb,blood oxygen saturation (SO2) of restrictive blood transfusion combined with HBOPC group were significantly increased(P ＜ 0.05);the red blood cell transfusion,red blood cell transfusion rate,incidence of pneumonia,wound infection rate were significantly decreased (P＜0.05).Conclusion:Restrictive blood transfusion combined with hyperbaric oxygen preconditioning could improve the anoxic state of the hip,knee arthroplasty patients,which could effectively reduce red blood cell transfusion,reduce postoperative complications,has good clinical curative effect.