{"id":18087,"date":"2019-12-13T04:42:31","date_gmt":"2019-12-12T20:42:31","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=18087"},"modified":"2019-12-24T05:45:53","modified_gmt":"2019-12-23T21:45:53","slug":"18087","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=18087","title":{"rendered":"[JAMA\u6700\u65b0\u8bba\u6587]\uff1a\u8f93\u6ce8\u65b0\u9c9c\u4e0e\u6807\u51c6\u7ea2\u7ec6\u80de\u5bf9\u5371\u91cd\u75c5\u60a3\u513fMODS\u7684\u5f71\u54cd"},"content":{"rendered":"\n

Original Investigation December 10, 2019<\/p>\n\n\n\n

Effect of Fresh vs Standard-issue Red Blood Cell Transfusions on Multiple Organ Dysfunction Syndrome in Critically Ill Pediatric Patients: A Randomized Clinical Trial<\/h1>\n\n\n\n

Philip C. Spinella, Marisa Tucci, Dean A. Fergusson, et al<\/h3>\n\n\n\n

JAMA. <\/em>2019;322(22):2179-2190. doi:10.1001\/jama.2019.17478<\/h3>\n\n\n\n

Importance<\/strong> \u80cc\u666f<\/h3>\n\n\n\n

The clinical consequences of red blood cell storage age for critically ill pediatric patients have not been examined in a large, randomized clinical trial.<\/p>\n\n\n\n

\u7ea2\u7ec6\u80de\u50a8\u5b58\u671f\u5bf9\u4e8e\u5371\u91cd\u75c5\u60a3\u513f\u7684\u4e34\u5e8a\u7ed3\u5c40\u5c1a\u672a\u7ecf\u8fc7\u5927\u89c4\u6a21\u968f\u673a\u4e34\u5e8a\u8bd5\u9a8c\u7684\u9a8c\u8bc1\u3002<\/p>\n\n\n\n

Objective<\/strong> \u76ee\u7684<\/h3>\n\n\n\n

To determine if the transfusion of fresh red blood cells (stored \u22647 days) reduced new or progressive multiple organ dysfunction syndrome compared with the use of standard-issue red blood cells in critically ill children.<\/p>\n\n\n\n

\u4e0e\u8f93\u6ce8\u6807\u51c6\u7684\u7ea2\u7ec6\u80de\u76f8\u6bd4\uff0c\u786e\u5b9a\u5371\u91cd\u75c5\u60a3\u513f\u8f93\u6ce8\u65b0\u9c9c\u7ea2\u7ec6\u80de (\u50a8\u5b58\u671f \u22647 \u5929) \u80fd\u5426\u51cf\u5c11\u65b0\u53d1MODS\u6216MODS\u8fdb\u5c55\u3002<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong> \u8bd5\u9a8c\u8bbe\u8ba1\uff0c\u573a\u666f\u53ca\u7814\u7a76\u4eba\u7fa4<\/h3>\n\n\n\n

The Age of Transfused Blood in Critically-Ill Children trial was an international, multicenter, blinded, randomized clinical trial, performed between February 2014 and November 2018 in 50 tertiary care centers. Pediatric patients between the ages of 3 days and 16 years were eligible if the first red blood cell transfusion was administered within 7 days of intensive care unit admission. A total of 15\u202f568 patients were screened, and 13\u202f308 were excluded.<\/p>\n\n\n\n

ABC-PICU\u8bd5\u9a8c\u662f\u4e00\u9879\u56fd\u9645\u591a\u4e2d\u5fc3\u3001\u8bbe\u76f2\u3001\u968f\u673a\u4e34\u5e8a\u8bd5\u9a8c\uff0c\u4ece2014\u5e742\u6708\u81f32018\u5e7411\u6708\u572850\u4e2a\u4e09\u7ea7\u533b\u5b66\u4e2d\u5fc3\u8fdb\u884c\u3002\u5165\u9009\u6807\u51c6\u4e3a\u5e74\u9f84\u57283\u5929\u81f316\u5c81\uff0c\u4e14\u5728\u5165\u4f4fICU\u6700\u521d7\u5929\u5185\u63a5\u53d7\u9996\u6b21\u8f93\u6ce8\u7ea2\u7ec6\u80de\u3002\u5171\u7b5b\u67e515568\u540d\u60a3\u513f\uff0c13308\u540d\u88ab\u6392\u9664\u3002<\/p>\n\n\n\n

Interventions<\/strong> \u5e72\u9884\u63aa\u65bd<\/h3>\n\n\n\n

Patients were randomized to receive either fresh or standard-issue red blood cells. A total of 1538 patients were randomized with 768 patients in the fresh red blood cell group and 770 in the standard-issue group.<\/p>\n\n\n\n

\u5165\u9009\u60a3\u513f\u88ab\u968f\u673a\u5206\u7ec4\uff0c\u5206\u522b\u63a5\u53d7\u8f93\u6ce8\u65b0\u9c9c\u6216\u6807\u51c6\u7ea2\u7ec6\u80de\u3002\u5171\u67091538\u540d\u60a3\u513f\u63a5\u53d7\u968f\u673a\u5206\u7ec4\uff0c768\u540d\u60a3\u513f\u5206\u81f3\u65b0\u9c9c\u7ea2\u7ec6\u80de\u7ec4\uff0c770\u540d\u5206\u81f3\u6807\u51c6\u7ec4\u3002<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong> \u4e3b\u8981\u9884\u540e\u6307\u6807<\/h3>\n\n\n\n

The primary outcome measure was new or progressive multiple organ dysfunction syndrome, measured for 28 days or to discharge or death.<\/p>\n\n\n\n

\u4e3b\u8981\u9884\u540e\u6307\u6807\u4e3a28\u5929\u6216\u51fa\u9662\u6216\u6b7b\u4ea1\u65f6\u65b0\u53d1MODS\u6216MODS\u8fdb\u5c55\u3002<\/p>\n\n\n\n

Results<\/strong> \u7ed3\u679c<\/h3>\n\n\n\n

Among 1538 patients who were randomized, 1461 patients (95%) were included in the primary analysis (median age, 1.8 years; 47.3% girls), in which there were 728 patients randomized to the fresh red blood cell group and 733 to the standard-issue group. The median storage duration was 5 days (interquartile range [IQR], 4-6 days) in the fresh group vs 18 days (IQR, 12-25 days) in the standard-issue group (P<\/em>\u2009<\u2009.001). There were no significant differences in new or progressive multiple organ dysfunction syndrome between fresh (147 of 728 [20.2%]) and standard-issue red blood cell groups (133 of 732 [18.2%]), with an unadjusted absolute risk difference of 2.0% (95% CI, \u20132.0% to 6.1%; P<\/em>\u2009=\u2009.33). The prevalence of sepsis was 25.8% (160 of 619) in the fresh group and 25.3% (154 of 608) in the standard-issue group. The prevalence of acute respiratory distress syndrome was 6.6% (41 of 619) in the fresh group and 4.8% (29 of 608) in the standard-issue group. Intensive care unit mortality was 4.5% (33 of 728) in the fresh group vs 3.5 % (26 of 732) in the standard-issue group (P<\/em>\u2009=\u2009.34).<\/p>\n\n\n\n

\u5728 1538 \u540d\u63a5\u53d7\u968f\u673a\u5206\u7ec4\u7684\u60a3\u513f\u4e2d\uff0c1461 \u540d (95%) \u60a3\u513f\u7eb3\u5165\u4e3b\u8981\u5206\u6790 (\u4e2d\u4f4d\u5e74\u9f84, 1.8 \u5c81; 47.3% \u5973\u5b69)\uff0c\u5176\u4e2d 728 \u540d\u60a3\u513f\u968f\u673a\u5206\u81f3\u65b0\u9c9c\u7ea2\u7ec6\u80de\u7ec4\uff0c733 \u540d\u5206\u81f3\u6807\u51c6\u7ec4\u3002\u65b0\u9c9c\u7ec4\u7ea2\u7ec6\u80de\u4e2d\u4f4d\u50a8\u5b58\u671f\u4e3a 5 \u5929 (\u56db\u5206\u4f4d\u533a\u95f4 [IQR], 4-6 \u5929)\uff0c\u6807\u51c6\u7ec4\u4e3a 18 \u5929 (IQR, 12-25 \u5929) (P<\/em>\u2009<\u2009.001)\u3002\u65b0\u9c9c\u7ea2\u7ec6\u80de\u7ec4\u4e0e\u6807\u51c6\u7ea2\u7ec6\u80de\u7ec4\u95f4\u65b0\u53d1\u6216\u8fdb\u5c55MODS\u65e0\u663e\u8457\u5dee\u5f02 (147\/728 [20.2%] vs 133\/732 [18.2%])\uff0c\u672a\u6821\u6b63\u98ce\u9669\u5dee\u5f02 2.0% (95% CI, \u20132.0% to 6.1%; P<\/em>\u2009=\u2009.33)\u3002\u65b0\u9c9c\u7ec4\u5168\u8eab\u6027\u611f\u67d3\u53d1\u751f\u7387\u4e3a 25.8% (160\/619)\uff0c\u6807\u51c6\u7ec4\u4e3a 25.3% (154\/608)\u3002\u65b0\u9c9c\u7ec4\u548c\u6807\u51c6\u7ec4\u6025\u6027\u547c\u5438\u7a98\u8feb\u7efc\u5408\u5f81\u53d1\u751f\u7387\u5206\u522b\u4e3a 6.6% (41\/619) \u548c 4.8% (29\/608)\u3002\u65b0\u9c9c\u7ec4ICU\u75c5\u6b7b\u7387\u4e3a 4.5% (33\/728)\uff0c\u6807\u51c6\u7ec4\u4e3a 3.5% (26\/732) (P<\/em>\u2009=\u2009.34)\u3002<\/p>\n\n\n\n

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

Conclusions and Relevance<\/strong> \u7ed3\u8bba<\/h3>\n\n\n\n

Among critically ill pediatric patients, the use of fresh red blood cells did not reduce the incidence of new or progressive multiple organ dysfunction syndrome (including mortality) compared with standard-issue red blood cells.<\/p>\n\n\n\n

\u5bf9\u4e8e\u5371\u91cd\u75c5\u60a3\u513f\uff0c\u4e0e\u8f93\u6ce8\u6807\u51c6\u7ea2\u7ec6\u80de\u76f8\u6bd4\uff0c\u8f93\u6ce8\u65b0\u9c9c\u7ea2\u7ec6\u80de\u4e0d\u80fd\u51cf\u5c11\u65b0\u53d1\u6216\u8fdb\u5c55MODS\uff08\u5305\u62ec\u6b7b\u4ea1\uff09\u7684\u53d1\u751f\u7387\u3002<\/p>\n\n\n\n

Trial Registration<\/strong> \u8bd5\u9a8c\u6ce8\u518c<\/h3>\n\n\n\n

ClinicalTrials.gov Identifier: NCT01977547<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation December 10, 2019 […]<\/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\/18087"}],"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=18087"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18087\/revisions"}],"predecessor-version":[{"id":18089,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18087\/revisions\/18089"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=18087"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=18087"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=18087"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}