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近期在線發(fā)表于《柳葉刀》的一項(xiàng)研究表明，術(shù)前輸血能降低鐮狀細(xì)胞病患者圍手術(shù)期并發(fā)癥的發(fā)生。

目前對(duì)于術(shù)前輸血能否給鐮狀細(xì)胞病患者帶來獲益尚無統(tǒng)一的意見。由于圍手術(shù)期并發(fā)癥常見于鐮狀細(xì)胞患者，英國(guó)Guy’s and St Thomas醫(yī)院的Jo Howard博士等評(píng)估選擇術(shù)前輸血患者的其圍手術(shù)期并發(fā)癥發(fā)生率。

該前瞻性多中心隨機(jī)對(duì)照研究在四個(gè)國(guó)家22家醫(yī)院進(jìn)行開展。入組的受試者為年齡至少為1歲、鐮狀細(xì)胞貧血(SS)或鐮狀β°-地中海貧血(Sβ°)、并且準(zhǔn)備進(jìn)行低危（如腹股溝疝修補(bǔ)術(shù)、腺樣體切除術(shù)）或中危（如膽囊切除術(shù)、關(guān)節(jié)置換術(shù)）手術(shù)。排除符合上述入組標(biāo)準(zhǔn)的患者被隨機(jī)分為兩組，一組在術(shù)前不進(jìn)行輸血，另一組在術(shù)前10天內(nèi)進(jìn)行輸血。研究的主要結(jié)局是在隨機(jī)化和術(shù)后30天出現(xiàn)重要并發(fā)癥的患者所占的比例。采用意向治療對(duì)研究結(jié)果進(jìn)行分析。

研究納入了70名患者，最終分析了67名患者數(shù)據(jù)，其中33名未進(jìn)行術(shù)前輸血，34名在術(shù)前進(jìn)行了輸血。納入分析的67名患者中，65名患者的血紅蛋白為SS亞型，54名患者擬進(jìn)行中危手術(shù)。術(shù)前未輸血組中13人發(fā)生了臨床重要并發(fā)癥，而術(shù)前輸血組中僅5人，所占比例分別為39%和15%。在出現(xiàn)并發(fā)癥患者中，兩組分別有10人（30%）和1人（3%）出現(xiàn)嚴(yán)重不良反應(yīng)。沒有調(diào)整的臨床重要并發(fā)癥的比值比為3.8%，95%可信區(qū)間為1.2~12.2。這11名出現(xiàn)嚴(yán)重不良反應(yīng)的患者中有10人（91%）出現(xiàn)了急性胸痛綜合征，其中9人術(shù)前未輸血，1人進(jìn)行術(shù)前輸血。在兩組間，研究者們并未發(fā)現(xiàn)存在住院天數(shù)和再次入院率的差別。

研究結(jié)果指出，在鐮狀細(xì)胞病患者中進(jìn)行術(shù)前輸血能降低患者圍手術(shù)期并發(fā)癥的發(fā)生率，特別是能改善擬進(jìn)行低危和中危手術(shù)的血紅蛋白SS亞型的患者在圍手術(shù)期并發(fā)癥的產(chǎn)生。

BACKGROUND: No consensus exists on whether preoperative blood transfusions are beneficial in patients with sickle-cell disease. We assessed whether perioperative complication rates would be altered by preoperative transfusion. METHODS: We did a multicentre, randomised trial. Eligible patients were aged at least 1 year, had haemoglobin SS or Sβ(0)thalassaemia sickle-cell-disease subtypes, and were scheduled for low-risk or medium-risk operations. Patients were randomly assigned no transfusion or transfusion no more than 10 days before surgery. The primary outcome was the proportion of clinically important complications between randomisation and 30 days after surgery. Analysis was by intention to treat. FINDINGS: 67 (96%) of 70 enrolled patients-33 no preoperative transfusion and 34 preoperative transfusion-were assessed. 65 (97%) of 67 patients had the haemoglobin SS subtype and 54 (81%) were scheduled to undergo medium-risk surgery. 13 (39%) of 33 patients in the no-preoperative-transfusion group had clinically important complications, compared with five (15%) in the preoperative-transfusion group (p=0·023). Of these, 10 (30%) and one (3%), respectively, had serious adverse events. The unadjusted odds ratio of clinically important complications was 3·8 (95% CI 1·2-12·2, p=0·027). 10 (91%) of 11 serious adverse events were acute chest syndrome (nine in the no-preoperative-transfusion group and one in the preoperative-transfusion group). Duration of hospital stay and readmission rates did not differ between study groups. INTERPRETATION: Preoperative transfusion was associated with decreased perioperative complications in patients with sickle-cell disease in this trial. This approach could, therefore, be beneficial for patients with the haemoglobin SS subtype who are scheduled to undergo low-risk and medium-risk surgeries. FUNDING: NHS Blood and Transplant.