{"id":17549,"date":"2019-08-15T05:08:34","date_gmt":"2019-08-14T21:08:34","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=17549"},"modified":"2019-08-28T22:51:31","modified_gmt":"2019-08-28T14:51:31","slug":"nejm%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87-%e9%9d%9e%e6%b4%b2%e9%9d%9e%e5%a4%8d%e6%9d%82%e6%80%a7%e4%b8%a5%e9%87%8d%e8%b4%ab%e8%a1%80%e5%84%bf%e7%ab%a5%e7%ab%8b%e5%8d%b3%e8%be%93%e8%a1%80","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=17549","title":{"rendered":"[NEJM\u53d1\u8868\u8bba\u6587]: \u975e\u6d32\u975e\u590d\u6742\u6027\u4e25\u91cd\u8d2b\u8840\u513f\u7ae5\u7acb\u5373\u8f93\u8840"},"content":{"rendered":"\n

ORIGINAL ARTICLE<\/a><\/p>\n\n\n\n

Immediate Transfusion in African Children with Uncomplicated Severe Anemia<\/h1>\n\n\n\n

Kathryn Maitland, Sarah Kiguli, Peter Olupot-Olupot, et al.<\/h3>\n\n\n\n

N Engl J Med 2019; 381:407-419
DOI: 10.1056\/NEJMoa1900105<\/h3>\n\n\n\n

Abstract<\/h2>\n\n\n\n

BACKGROUND \u80cc\u666f<\/h3>\n\n\n\n

The World Health Organization recommends not performing transfusions in African children hospitalized for uncomplicated severe anemia (hemoglobin level of 4 to 6 g per deciliter and no signs of clinical severity). However, high mortality and readmission rates suggest that less restrictive transfusion strategies might improve outcomes.<\/p>\n\n\n\n

\u5bf9\u4e8e\u975e\u590d\u6742\u6027\u4e25\u91cd\u8d2b\u8840\uff08\u8840\u7ea2\u86cb\u767d\u6c34\u5e734-6 g\/dL\u4e14\u6ca1\u6709\u75c5\u60c5\u4e25\u91cd\u7684\u4e34\u5e8a\u8868\u73b0\uff09\u7684\u975e\u6d32\u513f\u7ae5\uff0cWHO\u63a8\u8350\u4e0d\u4e88\u8f93\u8840\u3002\u7136\u800c\uff0c\u8fd9\u4e9b\u60a3\u513f\u7684\u9ad8\u75c5\u6b7b\u7387\u53ca\u518d\u5165\u9662\u7387\u63d0\u793a\uff0c\u975e\u9650\u5236\u6027\u8f93\u8840\u7b56\u7565\u53ef\u80fd\u6539\u5584\u9884\u540e\u3002<\/p>\n\n\n\n

METHODS \u65b9\u6cd5<\/h3>\n\n\n\n

In this factorial, open-label, randomized, controlled trial, we assigned Ugandan and Malawian children 2 months to 12 years of age with uncomplicated severe anemia to immediate transfusion with 20 ml or 30 ml of whole-blood equivalent per kilogram of body weight, as determined in a second simultaneous randomization, or no immediate transfusion (control group), in which transfusion with 20 ml of whole-blood equivalent per kilogram was triggered by new signs of clinical severity or a drop in hemoglobin to below 4 g per deciliter. The primary outcome was 28-day mortality. Three other randomizations investigated transfusion volume, postdischarge supplementation with micronutrients, and postdischarge prophylaxis with trimethoprim\u2013sulfamethoxazole.<\/p>\n\n\n\n

\u5728\u8fd9\u9879\u6790\u56e0\u8bbe\u8ba1\u3001\u5f00\u653e\u6807\u7b7e\u3001\u968f\u673a\u5bf9\u7167\u8bd5\u9a8c\u4e2d\uff0c\u6211\u4eec\u5c06\u4f34\u6709\u975e\u590d\u6742\u6027\u4e25\u91cd\u8d2b\u8840\u76842\u4e2a\u6708\u81f312\u5c81\u4e4c\u5e72\u8fbe\u548c\u9a6c\u62c9\u7ef4\u513f\u7ae5\u968f\u673a\u5206\u7ec4\uff0c\u63a5\u53d7\u7acb\u5373\u8f93\u884020 ml\u621630 ml\u7b49\u91cf\u5168\u8840\/kg\uff08\u6839\u636e\u7b2c\u4e8c\u4e2a\u968f\u673a\u5206\u7ec4\uff09\uff0c\u6216\u975e\u7acb\u5373\u8f93\u8840\uff08\u5bf9\u7167\u7ec4\uff09\uff0c\u5373\u5f53\u51fa\u8840\u75c5\u60c5\u52a0\u91cd\u7684\u65b0\u4f53\u5f81\u6216\u8840\u7ea2\u86cb\u767d\u6c34\u5e73\u4f4e\u4e8e4 g\/dL\u65f6\u8f93\u7b49\u91cf\u5168\u884020 ml\/kg\u3002\u4e3b\u8981\u9884\u540e\u6307\u6807\u4e3a28\u5929\u75c5\u6b7b\u7387\u3002\u5176\u4ed63\u9879\u968f\u673a\u5206\u7ec4\u5305\u62ec\u8f93\u8840\u91cf\u3001\u51fa\u9662\u540e\u8865\u5145\u5fae\u91cf\u8425\u517b\u7d20\u53ca\u51fa\u9662\u540e\u4f7f\u7528\u590d\u65b9\u65b0\u8bfa\u660e\u9884\u9632\u3002<\/p>\n\n\n\n

RESULTS \u7ed3\u679c<\/h3>\n\n\n\n

A total of 1565 children (median age, 26 months) underwent randomization, with 778 assigned to the immediate-transfusion group and 787 to the control group; 984 children (62.9%) had malaria. The children were followed for 180 days, and 71 (4.5%) were lost to follow-up. During the primary hospitalization, transfusion was performed in all the children in the immediate-transfusion group and in 386 (49.0%) in the control group (median time to transfusion, 1.3 hours vs. 24.9 hours after randomization). The mean (\u00b1SD) total blood volume transfused per child was 314\u00b1228 ml in the immediate-transfusion group and 142\u00b1224 ml in the control group. Death had occurred by 28 days in 7 children (0.9%) in the immediate-transfusion group and in 13 (1.7%) in the control group (hazard ratio, 0.54; 95% confidence interval [CI], 0.22 to 1.36; P=0.19) and by 180 days in 35 (4.5%) and 47 (6.0%), respectively (hazard ratio, 0.75; 95% CI, 0.48 to 1.15), without evidence of interaction with other randomizations (P>0.20) or evidence of between-group differences in readmissions, serious adverse events, or hemoglobin recovery at 180 days. The mean length of hospital stay was 0.9 days longer in the control group.<\/p>\n\n\n\n

\u5171\u6709 1565 \u540d\u60a3\u513f\uff08\u4e2d\u4f4d\u5e74\u9f84\uff0c26\u4e2a\u6708\uff09\u63a5\u53d7\u968f\u673a\u5206\u7ec4\uff0c778 \u540d\u5206\u81f3\u7acb\u5373\u8f93\u8840\u7ec4\uff0c787 \u540d\u5206\u81f3\u5bf9\u7167\u7ec4\uff1b984 \u540d\u60a3\u513f (62.9%) \u4e3a\u759f\u75be\u3002\u968f\u8bbf\u81f3180\u5929\uff0c71 \u540d (4.5%) \u60a3\u513f\u5931\u8bbf\u3002\u5728\u9996\u6b21\u4f4f\u9662\u671f\u95f4\uff0c\u7acb\u5373\u8f93\u8840\u7ec4\u6240\u6709\u60a3\u513f\u5747\u63a5\u53d7\u8f93\u8840\uff0c\u5bf9\u7167\u7ec4\u4ec5\u6709 386 \u540d (49.0%) \u60a3\u513f\u63a5\u53d7\u8f93\u8840\uff08\u81f3\u8f93\u8840\u7684\u4e2d\u4f4d\u65f6\u95f4\uff0c\u968f\u673a\u5206\u7ec4\u540e 1.3 \u5c0f\u65f6 vs. 24.9 \u5c0f\u65f6\uff09\u3002\u7acb\u5373\u8f93\u8840\u7ec4\u6bcf\u540d\u60a3\u513f\u5e73\u5747 (\u00b1SD) \u8f93\u8840\u91cf 314\u00b1228 ml\uff0c\u5bf9\u7167\u7ec4 142\u00b1224 ml\u3002\u81f328\u5929\u65f6\uff0c\u7acb\u5373\u8f93\u8840\u7ec4 7 \u540d\u60a3\u513f (0.9%) \u6b7b\u4ea1\uff0c\u5bf9\u7167\u7ec4 13 \u540d\u60a3\u513f (1.7%) \u6b7b\u4ea1\uff08\u98ce\u9669\u6bd4\uff0c0.54\uff1b95% \u53ef\u4fe1\u533a\u95f4 [CI]\uff0c0.22 to 1.36; P=0.19\uff09\uff0c180\u5929\u65f6\u5206\u522b\u6709 35 \u540d (4.5%) \u548c 47 \u540d (6.0%) \u60a3\u513f\u6b7b\u4ea1\uff08\u98ce\u9669\u6bd4\uff0c0.75\uff1b95% CI, 0.48 to 1.15\uff09\uff0c\u4e14\u4e0e\u5176\u4ed6\u968f\u673a\u5206\u7ec4\u6ca1\u6709\u4ea4\u4e92\u4f5c\u7528\u7684\u8bc1\u636e (P>0.20)\uff0c\u4e24\u7ec4\u95f4180\u5929\u65f6\u518d\u4f4f\u9662\u7387\u3001\u4e25\u91cd\u4e0d\u826f\u4e8b\u4ef6\u6216\u8840\u7ea2\u86cb\u767d\u6062\u590d\u60c5\u51b5\u6ca1\u6709\u663e\u8457\u5dee\u5f02\u3002\u5bf9\u7167\u7ec4\u5e73\u5747\u4f4f\u9662\u65e5\u5ef6\u957f0.9\u5929\u3002<\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n

CONCLUSIONS \u7ed3\u8bba<\/h3>\n\n\n\n

There was no evidence of differences in clinical outcomes over 6 months between the children who received immediate transfusion and those who did not. The triggered-transfusion strategy in the control group resulted in lower blood use; however, the length of hospital stay was longer, and this strategy required clinical and hemoglobin monitoring.<\/p>\n\n\n\n

\u63a5\u53d7\u7acb\u5373\u8f93\u8840\u4e0e\u975e\u7acb\u5373\u8f93\u8840\u7684\u60a3\u513f6\u4e2a\u6708\u7684\u4e34\u5e8a\u9884\u540e\u6ca1\u6709\u663e\u8457\u5dee\u5f02\u3002\u5bf9\u7167\u7ec4\u6839\u636e\u4e34\u5e8a\u8868\u73b0\u7684\u8f93\u8840\u7b56\u7565\u53ef\u4ee5\u51cf\u5c11\u8840\u6db2\u7684\u4f7f\u7528\uff1b\u7136\u800c\u4f4f\u9662\u65e5\u8f83\u957f\uff0c\u4e14\u9700\u8981\u76d1\u6d4b\u4e34\u5e8a\u8868\u73b0\u53ca\u8840\u7ea2\u86cb\u767d\u6c34\u5e73\u3002<\/p>\n\n\n\n

(Funded by the Medical Research Council and Department for International Development; TRACT Current Controlled Trials number,\u00a0ISRCTN84086586opens in new tab<\/a>.)<\/p>\n\n\n\n

\u8bc4\u8bba[\u4ec5\u4ee3\u8868\u4e2a\u4eba\u610f\u89c1]<\/h3>\n\n\n\n
  • \u8fd9\u9879\u7814\u7a76\u518d\u5ea6\u8868\u660e\uff0c\u5982\u679c\u5f02\u5e38\u7684\u751f\u7406\u6307\u6807\u4e0d\u4f34\u968f\u4e34\u5e8a\u75c5\u60c5\u52a0\u91cd\u6216\u5931\u4ee3\u507f\u8868\u73b0\uff0c\u5c06\u5176\u7ea0\u6b63\u5230\u6b63\u5e38\u8303\u56f4\u6216\u63a5\u8fd1\u6b63\u5e38\u8303\u56f4\u53ef\u80fd\u5e76\u65e0\u610f\u4e49<\/li>
  • \u5bf9\u4e8e\u4e34\u5e8a\u533b\u751f\u800c\u8a00\uff0c\u6211\u4eec\u90fd\u77e5\u9053\uff0c\u6bcf\u4f4d\u60a3\u8005\u90fd\u53ef\u4ee5\u8010\u53d7\u4e00\u5b9a\u7a0b\u5ea6\u7684\u751f\u7406\u6307\u6807\u5f02\u5e38\u800c\u65e0\u9700\u7ea0\u6b63\u3002\u4f46\u662f\uff0c\u6700\u96be\u7684\u95ee\u9898\u53ef\u80fd\u5728\u4e8e\uff0c\u5bf9\u4e8e\u67d0\u4f4d\u60a3\u8005\u800c\u8a00\uff0c\u5982\u4f55\u786e\u5b9a\u4f55\u79cd\u7a0b\u5ea6\u7684\u5f02\u5e38\u53ef\u4ee5\u8010\u53d7\u6216\u4e0d\u80fd\u8010\u53d7<\/li>
  • \u4e3b\u8981\u5b8c\u6210\u4ebaKathryn Maitland\u662f\u4e2a\u82f1\u56fd\u4eba\uff0c\u5728\u975e\u6d32\u5de5\u4f5c\u591a\u5e74\u3002\u76f8\u4fe1\u524d\u4e9b\u5e74\u5979\u4e3b\u6301\u5b8c\u6210\u7684FEAST\u7814\u7a76\uff08\u8bc1\u5b9e\u5bf9\u4e8e\u611f\u67d3\u5408\u5e76\u4f4e\u8840\u538b\u7684\u975e\u6d32\u513f\u7ae5\uff0c\u8f93\u6db2\u53ef\u80fd\u589e\u52a0\u75c5\u6b7b\u7387\uff09\u5927\u5bb6\u8fd8\u8bb0\u5fc6\u72b9\u65b0<\/li>
  • \u660e\u5929\u4ecb\u7ecd\u7684\u4ecd\u7136\u662fMaitland\u53ca\u5176\u540c\u4e8b\u7684\u53e6\u4e00\u9879\u7814\u7a76\u7ed3\u679c<\/li>
  • \u6211\u4eec\u603b\u662f\u62b1\u6028\u6ca1\u6709\u4e34\u5e8a\u7814\u7a76\u7684\u8d44\u6e90\u3002\u771f\u7684\u662f\u8fd9\u6837\u7684\u5417\uff1f\u53ef\u80fd\u66f4\u591a\u7684\u662f\u6ca1\u6709\u60f3\u6cd5\u3001\u610f\u613f\u548c\u4ed8\u51fa<\/li><\/ul>\n\n\n\n

    <\/p>\n","protected":false},"excerpt":{"rendered":"

    ORIGINAL ARTICLE Immediate Transfusion in African Child […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17549"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=17549"}],"version-history":[{"count":3,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17549\/revisions"}],"predecessor-version":[{"id":17572,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17549\/revisions\/17572"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=17549"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=17549"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=17549"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}