开放性输血策略与限制性输血策略对超低出生体重儿的存活和神经认知结局的影响:一项随机对照试验的系统综述和荟萃分析

doi:10.3969/j.issn.1671-2587.2022.02.015

临床输血与检验 ›› 2022, Vol. 24 ›› Issue (2): 211-217.DOI: 10.3969/j.issn.1671-2587.2022.02.015

开放性输血策略与限制性输血策略对超低出生体重儿的存活和神经认知结局的影响:一项随机对照试验的系统综述和荟萃分析

张永生, 郑维威, 刘常青

215399 江苏省昆山市第二人民医院输血科（张永生）; 江苏省昆山市第二人民医院儿科（刘常青）; 中国科学技术大学附属第一医院检验科（郑维威）

收稿日期:2021-08-04 发布日期:2022-04-12
通讯作者: 郑维威,男,副主任技师,博士,主要从事肿瘤分子生物学研究,（E-mail）zhengweiwei2009@163.com。
作者简介:张永生（1981-）,男,副主任技师,学士,主要从事输血技术研究,（E-mail）yszhanglab@dingtalk.com。

Effects of Liberal Versus Restrictive Transfusion Thresholds on Survival and Neurocognitive Outcomes in Extremely Low-Birth-Weight Infants：a Systematic Review and Meta-analysis of Randomized Trials

ZHANG Yong-sheng, ZHENG Wei-wei, LIU Chang-qing

Department of Blood Transfusion,Kunshan Second People's Hospital,Jiangsu 215399

Received:2021-08-04 Published:2022-04-12

摘要/Abstract

摘要： 目的比较开放性输血策略和限制性输血策略对超低出生体重（ELBW）儿的死亡和神经发育的影响。方法纳入比较两种输血策略对ELBW婴儿预后影响的随机对照试验,并进行了系统评价和荟萃分析;在18~26个月（校正年龄）测量的主要结局指标是死亡或神经发育障碍（后者包括认知延迟、脑瘫、严重听力或视力受损）;英文数据库搜索：Pubmed、Cochrane Central Register of controlled Trials、EMBASE、Clinicaltrials,检索截止日期是2021年2月1日。中文数据库检索了中国知网、万方、维普网、中国生物医学文献数据库,检索截止日期是2021年8月11日。对于二分类变量,计算风险比（RR）。结果共分析了来自3项随机对照试验的3 288名婴儿,其中1 657人被随机分配到限制性输血组,1 631人被分配到开放性输血组。两组之间的主要结局指标没有显著性差异（RR=1.01,95%CI=0.93~1.09,I²=7%,P>0.05）; 仅认知延迟的合成结果有统计学异质性（I²=60%,P=0.08）。结论对于ELBW婴儿,在校正年龄18~26个月时,限制性红细胞输注策略不会增加发生死亡或神经发育障碍的可能性。

关键词: 超低出生体重儿, 输血, 认知功能障碍, 存活

Abstract: Objective To compare the effects of liberal transfusion strategy and restrictive transfusion strategy on death and neurodevelopmental impairment of extremely low birth weight（ELBW）infants. Methods We included randomized controlled trials（RCTs） comparing the effects of two blood transfusion strategies on the prognosis of ELBW infants,and conducted systematic review and Meta-analysis. The primary outcomes,measured at 18~26 months（corrected age）,was death or a composite of neurodevelopmental impairment（cognitive delay,cerebral palsy, hearing loss,vision loss）. We searched following English databases,PubMed,Cochrane Central Register of controlled Trials,EMBASE,Clinicaltrials until February 1,2021. In the Chinese databases,we searched CNKI,Wanfang Database,VIP and CBM. The retrieval deadline was August 11,2021. For binary variables,we calculated risk ration（RR）. Results A total of 3 288 infants from 3 RCTs were analyzed. 1 657 infants were randomly assigned to the restrictive transfusion group and 1 631 infants to the liberal transfusion group. There was no significant difference in the primary outcomes between the two groups （RR=1.01, 95%CI=0.93~1.09,I²=7%,P>0.05）. Statistical heterogeneity was observed only in the synthesized results of cognitive delay（I²=60%,P=0.08）. Conclusions For ELBW infants,restrictive transfusion strategy did not increase the likelihood of death or neurodevelopmental impairment at 18~26 months of corrected age.

Key words: Infant extremely low birth weight, Blood transfusion, Cognitive dysfunction, Survival

中图分类号:

R457

张永生, 郑维威, 刘常青. 开放性输血策略与限制性输血策略对超低出生体重儿的存活和神经认知结局的影响:一项随机对照试验的系统综述和荟萃分析[J]. 临床输血与检验, 2022, 24(2): 211-217.

ZHANG Yong-sheng, ZHENG Wei-wei, LIU Chang-qing. Effects of Liberal Versus Restrictive Transfusion Thresholds on Survival and Neurocognitive Outcomes in Extremely Low-Birth-Weight Infants：a Systematic Review and Meta-analysis of Randomized Trials[J]. JOURNAL OF CLINICAL TRANSFUSION AND LABORATORY MEDICINE, 2022, 24(2): 211-217.

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开放性输血策略与限制性输血策略对超低出生体重儿的存活和神经认知结局的影响:一项随机对照试验的系统综述和荟萃分析

Effects of Liberal Versus Restrictive Transfusion Thresholds on Survival and Neurocognitive Outcomes in Extremely Low-Birth-Weight Infants：a Systematic Review and Meta-analysis of Randomized Trials

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