{"id":17550,"date":"2019-08-17T05:16:44","date_gmt":"2019-08-16T21:16:44","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=17550"},"modified":"2019-08-28T22:51:42","modified_gmt":"2019-08-28T14:51:42","slug":"nejm%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e9%9d%9e%e6%b4%b2%e4%b8%a5%e9%87%8d%e8%b4%ab%e8%a1%80%e5%84%bf%e7%ab%a5%e7%9a%84%e8%be%93%e8%a1%80%e9%87%8f","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=17550","title":{"rendered":"[NEJM\u53d1\u8868\u8bba\u6587]\uff1a\u975e\u6d32\u4e25\u91cd\u8d2b\u8840\u513f\u7ae5\u7684\u8f93\u8840\u91cf"},"content":{"rendered":"\n

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

Transfusion Volume for Children with Severe Anemia in Africa<\/h1>\n\n\n\n

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

N Engl J Med 2019; 381:420-431
DOI: 10.1056\/NEJMoa1900100<\/h3>\n\n\n\n

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

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

Severe anemia (hemoglobin level, <6 g per deciliter) is a leading cause of hospital admission and death in children in sub-Saharan Africa. The World Health Organization recommends transfusion of 20 ml of whole-blood equivalent per kilogram of body weight for anemia, regardless of hemoglobin level.<\/p>\n\n\n\n

\u4e25\u91cd\u8d2b\u8840\uff08\u8840\u7ea2\u86cb\u767d< 6 g\/dL\uff09\u662f\u6492\u54c8\u62c9\u4ee5\u5357\u975e\u6d32\u5730\u533a\u513f\u7ae5\u4f4f\u9662\u53ca\u6b7b\u4ea1\u7684\u9996\u8981\u539f\u56e0\u3002WHO\u63a8\u8350\uff0c\u65e0\u8bba\u8840\u7ea2\u86cb\u767d\u6c34\u5e73\u6c34\u5e73\uff0c\u5e94\u5f53\u8f93\u6ce820 ml\u7b49\u91cf\u5168\u8840\/kg\u6cbb\u7597\u8d2b\u8840\u3002<\/p>\n\n\n\n

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

In this factorial, open-label trial, we randomly assigned Ugandan and Malawian children 2 months to 12 years of age with a hemoglobin level of less than 6 g per deciliter and severity features (e.g., respiratory distress or reduced consciousness) to receive immediate blood transfusion with 20 ml per kilogram or 30 ml per kilogram. Three other randomized analyses investigated immediate as compared with no immediate transfusion, the administration of postdischarge micronutrients, and postdischarge prophylaxis with trimethoprim\u2013sulfamethoxazole. The primary outcome was 28-day mortality.<\/p>\n\n\n\n

\u5728\u8fd9\u9879\u6790\u56e0\u8bbe\u8ba1\u3001\u5f00\u653e\u6807\u7b7e\u8bd5\u9a8c\u4e2d\uff0c\u6211\u4eec\u5c06\u4f34\u6709\u8840\u7ea2\u86cb\u767d\u6c34\u5e73\u4f4e\u4e8e6 g\/L\u4e14\u6709\u75c5\u60c5\u4e25\u91cd\u8868\u73b0\uff08\u5982\u547c\u5438\u7a98\u8feb\u6216\u610f\u8bc6\u969c\u788d\uff09\u76842\u4e2a\u6708\u81f312\u5c81\u4e4c\u5e72\u8fbe\u548c\u9a6c\u62c9\u7ef4\u513f\u7ae5\u968f\u673a\u5206\u7ec4\uff0c\u5206\u522b\u63a5\u53d7\u7acb\u5373\u8f93\u884020 ml\/kg\u621630 ml\/kg\u3002\u5176\u4ed63\u9879\u968f\u673a\u5206\u6790\u5305\u62ec\u7acb\u5373\u8f93\u8840\u4e0e\u975e\u7acb\u5373\u8f93\u8840\u7684\u6bd4\u8f83\uff0c\u51fa\u9662\u540e\u8865\u5145\u5fae\u91cf\u8425\u517b\u7d20\uff0c\u4ee5\u53ca\u51fa\u9662\u540e\u4f7f\u7528\u590d\u65b9\u65b0\u8bfa\u660e\u9884\u9632\u3002\u4e3b\u8981\u9884\u540e\u6307\u6807\u4e3a28\u5929\u75c5\u6b7b\u7387\u3002<\/p>\n\n\n\n

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

A total of 3196 eligible children (median age, 37 months; 2050 [64.1%] with malaria) were assigned to receive a transfusion of 30 ml per kilogram (1598 children) or 20 ml per kilogram (1598 children) and were followed for 180 days. A total of 1592 children (99.6%) in the higher-volume group and 1596 (99.9%) in the lower-volume group started transfusion (median, 1.2 hours after randomization). The mean (\u00b1SD) volume of total blood transfused per child was 475\u00b1385 ml and 353\u00b1348 ml, respectively; 197 children (12.3%) and 300 children (18.8%) in the respective groups received additional transfusions. Overall, 55 children (3.4%) in the higher-volume group and 72 (4.5%) in the lower-volume group died before 28 days (hazard ratio, 0.76; 95% confidence interval [CI], 0.54 to 1.08; P=0.12 by log-rank test). This finding masked significant heterogeneity in 28-day mortality according to the presence or absence of fever (>37.5\u00b0C) at screening (P=0.001 after Sidak correction). Among the 1943 children (60.8%) without fever, mortality was lower with a transfusion volume of 30 ml per kilogram than with a volume of 20 ml per kilogram (hazard ratio, 0.43; 95% CI, 0.27 to 0.69). Among the 1253 children (39.2%) with fever, mortality was higher with 30 ml per kilogram than with 20 ml per kilogram (hazard ratio, 1.91; 95% CI, 1.04 to 3.49). There was no evidence of differences between the randomized groups in readmissions, serious adverse events, or hemoglobin recovery at 180 days.<\/p>\n\n\n\n

\u603b\u5171 3196 \u540d\u7b26\u5408\u5165\u9009\u6807\u51c6\u7684\u513f\u7ae5\uff08\u4e2d\u4f4d\u5e74\u9f84\uff0c27\u4e2a\u6708\uff1b2050\u540d [64.1%] \u4e3a\u759f\u75be\uff09\u63a5\u53d7\u968f\u673a\u5206\u7ec4\uff0c\u5206\u522b\u63a5\u53d7\u8f93\u8840 30 ml\/kg\uff081598 \u540d\u513f\u7ae5\uff09\u6216 20 ml\/kg\uff081598 \u540d\u513f\u7ae5\uff09\uff0c\u968f\u8bbf\u81f3180\u5929\u3002\u9ad8\u5bb9\u91cf\u7ec4 1592 \u540d\u513f\u7ae5 (99.6%) \u4e0e\u4f4e\u5bb9\u91cf\u7ec4 1596 \u540d\u513f\u7ae5 (99.9%) \u5f00\u59cb\u8f93\u8840\uff08\u4e2d\u4f4d\u65f6\u95f4\uff0c\u968f\u673a\u5206\u7ec4\u540e1.2 \u5c0f\u65f6\uff09\u3002\u6bcf\u540d\u60a3\u513f\u5e73\u5747 (\u00b1SD) \u8f93\u8840\u91cf\u5206\u522b\u4e3a 475\u00b1385 ml \u548c 353\u00b1348 ml\uff1b\u4e24\u7ec4\u5206\u522b\u6709 197 \u540d\u60a3\u513f (12.3%) \u548c 300 \u540d\u60a3\u513f (18.8%) \u63a5\u53d7\u4e86\u989d\u5916\u8f93\u8840\u3002\u9ad8\u5bb9\u91cf\u7ec4 55 \u540d\u60a3\u513f (3.4%) \u4e0e\u4f4e\u5bb9\u91cf\u7ec4 72 \u540d\u60a3\u513f (4.5%) \u572828\u5929\u524d\u6b7b\u4ea1\uff08\u98ce\u9669\u6bd4\uff0c0.76\uff1b95% \u53ef\u4fe1\u533a\u95f4 [CI], 0.54 to 1.08\uff1blog-rank\u68c0\u9a8c P=0.12\uff09\u3002\u4e0a\u8ff0\u7ed3\u679c\u63a9\u76d6\u4e86\u7b5b\u67e5\u65f6\u662f\u5426\u53d1\u70ed (>37.5\u00b0C) \u4f34\u968f\u768428\u5929\u75c5\u6b7b\u7387\u7684\u663e\u8457\u5dee\u5f02\u6027\uff08 Sidak\u6821\u6b63\u540e P=0.001\uff09\u3002\u5728\u6ca1\u6709\u53d1\u70ed\u7684 1943 \u540d\u60a3\u513f (60.8%)\uff0c\u4e0e\u8f93\u884020 ml\/kg\u76f8\u6bd4\uff0c\u8f93\u8840 30 ml\/kg \u7ec4\u75c5\u6b7b\u7387\u663e\u8457\u964d\u4f4e\uff08\u98ce\u9669\u6bd4 0.43\uff1b95% CI, 0.27 to 0.69\uff09\u3002\u5bf9\u4e8e 1253 \u540d\u53d1\u70ed\u60a3\u513f (39.2%) \uff0c\u8f93\u884030 ml\/kg\u7ec4\u75c5\u6b7b\u7387\u9ad8\u4e8e 20 ml\/kg\u7ec4\uff08\u98ce\u9669\u6bd4 1.91\uff1b95% CI, 1.04 to 3.49\uff09\u3002\u4e24\u7ec4\u60a3\u513f180\u5929\u5185\u518d\u5165\u9662\u7387\u3001\u4e25\u91cd\u4e0d\u826f\u4e8b\u4ef6\u6216\u8840\u7ea2\u86cb\u767d\u6062\u590d\u60c5\u51b5\u65e0\u663e\u8457\u5dee\u5f02\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

Overall mortality did not differ between the two transfusion strategies.<\/p>\n\n\n\n

\u4e24\u79cd\u4e0d\u540c\u7684\u8f93\u8840\u7b56\u7565\u4e4b\u95f4\u75c5\u6b7b\u7387\u5e76\u65e0\u5dee\u5f02\u3002<\/p>\n\n\n\n

(Funded by the Medical Research Council and Department for International Development, United Kingdom; TRACT Current Controlled Trials number,\u00a0ISRCTN84086586opens in new tab<\/a>.)<\/p>\n","protected":false},"excerpt":{"rendered":"

ORIGINAL ARTICLE Transfusion Volume for Children with S […]<\/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\/17550"}],"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=17550"}],"version-history":[{"count":3,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17550\/revisions"}],"predecessor-version":[{"id":17571,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17550\/revisions\/17571"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=17550"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=17550"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=17550"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}