60 岁以上患者心肺搭桥期间的综合患者血液管理计划

IF 3.6 3区医学

Clinical Interventions in Aging Pub Date : 2024-03-07 DOI:10.2147/cia.s443908

Qiaoni Zhang, Weidong Yan, Sizhe Gao, Xiaolin Diao, Gang Liu, Jing Wang, Bingyang Ji

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引用次数: 0

摘要

目的：对于接受心血管手术的老年人最合适的输血策略，目前尚未达成共识。我们旨在研究患者血液管理（PBM）计划对高龄患者的潜在益处，并评估心血管手术中年龄与 PBM 的关系：我们收集了接受泵上心血管手术的 60 岁以上患者的数据。我们采用倾向得分匹配法比较了PBM前组和PBM后组的输血和临床结果。然后，我们在原始队列中进行了亚组分析，特别是通过多变量调整模型对 75 岁及以上的患者进行了分析：结果：我们分析了 9703 名老年人的数据。心肺旁路（CPB）期间（31.6% vs 13.1%，P< 0.001）、手术期间（50.8% vs 39.0%，P< 0.001）和手术后（5.6% vs 3.1%，P< 0.001）的红细胞（RBC）输注率显著降低，PBM 后死亡率和一些不良事件的风险也有所降低。亚组分析显示，年龄与PBM之间不存在交互作用，高龄（75岁以上）并不影响PBM项目在减少RBC输注（Pinteraction=0.245）、降低死亡率（Pinteration=0.829）和某些并发症方面的效果：综合 PBM 计划可减少接受 CPB 的老年患者的红细胞输注，且不会产生不良后果。即使是 75 岁以上的患者也可从更严格的输血指征中获益。关键词：心肺旁路；心血管手术；老年人；患者血液管理；红细胞输注

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A Comprehensive Patient Blood Management Program During Cardiopulmonary Bypass in Patients Over 60 Years of Age

Purpose: There is currently no consensus on the most appropriate blood transfusion strategy for older adults undergoing cardiovascular surgery. We aimed to investigate the potential benefits of the patient blood management (PBM) program specifically for advanced age patients, and to evaluate the relationship of age and PBM in cardiovascular surgery.
Patients and Methods: We collected data from patients over 60 years old who underwent on-pump cardiovascular surgery. We compared transfusion and clinical outcomes between the pre-PBM and post-PBM groups using a propensity score matching method. Then, we conducted a subgroup analysis within the original cohort, specifically focusing on patients aged of 75 and above with multivariable adjusted models.
Results: Data of 9703 older adults were analyzed. Red blood cell (RBC) transfusion rates during cardiopulmonary bypass (CPB) (31.6% vs 13.1%, P< 0.001), during the operation (50.8% vs 39.0%, P< 0.001) and after the operation (5.6% vs 3.1%, P< 0.001) were significantly reduced, and mortality and the risk of some adverse events were also reduced after the PBM. Subgroup analysis showed that there was no interaction between age and PBM, and advanced age (over age 75) did not modify the effect of PBM program in reducing RBC transfusion (Pinteraction=0.245), on mortality (Pinteration=0.829) and on certain complications.
Conclusion: The comprehensive PBM program could reduce RBC transfusion without adverse outcomes in older patients undergoing CPB. Even patients over age 75 may benefit from a more stringent transfusion indication. Comprehensive blood conservation measures should be applied to optimize the blood management for older patients.

Keywords: cardiopulmonary bypass, cardiovascular surgery, older adults, patient blood management, red blood cell transfusion

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来源期刊

Clinical Interventions in Aging GERIATRICS & GERONTOLOGY-

CiteScore

6.20

自引率

2.80%

发文量

193

期刊介绍： Clinical Interventions in Aging, is an online, peer reviewed, open access journal focusing on concise rapid reporting of original research and reviews in aging. Special attention will be given to papers reporting on actual or potential clinical applications leading to improved prevention or treatment of disease or a greater understanding of pathological processes that result from maladaptive changes in the body associated with aging. This journal is directed at a wide array of scientists, engineers, pharmacists, pharmacologists and clinical specialists wishing to maintain an up to date knowledge of this exciting and emerging field.