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Perioperative Blood Management of Patients Using More Than or Equal to 20 Units of Blood
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摘要:
目的 探讨手术相关用血量大于等于20 U患者围术期血液管理特点。 方法 收集并分析北京协和医院2015年度用血量大于等于20 U手术患者的围术期资料, 比较未经历非计划二次手术和经历非计划二次手术患者的相关信息。 结果 共36例患者纳入研究, 经历非计划二次手术患者(n=12)初次择期手术中失血量明显低于未经历非计划二次手术患者(n=24), 分别为1300和3000 ml(P < 0.05);但非计划二次手术相较于其初次择期手术美国麻醉医师协会(American Society of Anaesthesiology, ASA)分级明显增高, Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ级分别为0、0、4、8、0例和2、9、1、0、0例; 术中出血量(分别为2250和1050 ml)和输血量(红细胞分别为8和1 U, 血浆分别为400和100 ml)亦均明显增加(P均 < 0.05)。36例患者中18例并发术前贫血。 结论 对于手术难度大、风险高的患者, 在充分评估术中出血风险的基础上, 采取个体化治疗方案, 纠正术前贫血, 术中严密止血, 加强围术期凝血功能检测, 可降低非计划二次手术的发生率, 改善患者结局。 -
关键词:
- 用血量大于等于20 U /
- 围术期 /
- 血液管理 /
- 非计划二次手术
Abstract:Objective To investigate blood management in perioperative period for patients using more than or equal to 20 units of blood. Methods Surgical patients using ≥ 20 units of blood in 2015 in Peking Union Medical College Hospital were included. Records regarding their perioperative period were collected, analyzed, and compared between the patients not receiving unplanned secondary surgery and those who received unplanned secondary surgery. Results Thirty-six patients were enrolled. The blood loss during the first surgery was significantly lower in the patients who did have unplanned secondary surgery (n=12) compared with those who did not(n=24) (1300 ml vs. 3000 ml, P < 0.05). Patients had higher American Society of Anesthesiology (ASA) grade in the unplanned secondary surgery compared with the primary surgery, with the number of cases classified as grade Ⅰ-Ⅴ being 0, 0, 4, 8, 0 and 2, 9, 1, 0, 0, respectively. Additionally, the average intraoperative blood loss (2250 ml vs. 1050 ml) and volume of blood transfusion (red blood cell, 8 U vs. 1 U; plasma, 400 ml vs. 100 ml) were higher in the unplanned secondary surgery than in the primary surgery (all P < 0.05). Eighteen patients were complicated with anemia before surgery. Conclusions For patients at high risk and receiving complex surgery, individualized treatment plan, therapy for anemia before selective surgery, careful hemostasis during operation, and perioperative monitoring of coagulation function may reduce the need for unplanned secondary surgery and improve patient outcome. -
表 1 18例贫血患者术前血红蛋白水平与手术时机
血红蛋白(g/L) 手术时机(例) 急诊手术 择期手术 90~120 1 7 60~＜90 3 5 30~＜60 2 0 ＜30 0 0 总计 6 12 
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表 2 未经历与经历非计划二次手术患者初次手术相关数据比较
非计划二次手术 例数 ASA分级(Ⅰ/Ⅱ/Ⅲ/Ⅳ/Ⅴ) 术中出血量(ml) 术后引流量(ml) 未经历 24 0/12/10/1/1 3000(1200, 6150) 2400( 650, 4543) 经历 12 2/9/1/0/0 1300( 650, 2000)* 3600(2450, 9950) ASA：美国麻醉医师协会；与未经历非计划二次手术患者比较，* P＜0.05
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[1] Soleimanha M, Haghighi M, Mirbolook A, et al. A survey on transfusion status in orthopedic surgery at a trauma center[J]. Arch Bone Jt Surg, 2016, 4:70-74. http://www.ncbi.nlm.nih.gov/pubmed/26894223 [2] Tsai HW, Hsieh FC, Chang CC, et al. Clinical practice of blood transfusion in orthotopic organ transplantation:a single institution experience[J]. Asian Pac J Cancer Prev, 2015, 16:8009-8013. doi: 10.7314/APJCP.2015.16.17.8009 [3] Kozek-Langenecker SA. Coagulation and transfusion in the postoperative bleeding patient[J]. Curr Opin Crit Care, 2014, 20:460-466. doi: 10.1097/MCC.0000000000000109 [4] Kozek-Langenecker SA, Afshari A, Albaladejo P, et al. Management of severe perioperative bleeding:guidelines from the European Society of Anaesthesiology[J]. Eur J Anaesthesiol, 2013, 30:270-382. doi: 10.1097/EJA.0b013e32835f4d5b [5] Goodnough LT, Maniatis A, Earnshaw P, et al. Detection, evaluation and management of preoperative anaemia in the elective orthopaedic surgical patient:NATA guidelines[J]. Br J Anaesth, 2011, 106:13-22. doi: 10.1093/bja/aeq361 [6] Clevenger B, Richards T. Preoperative anaemia[J]. Anaesthesia, 2015, 70:20-28. doi: 10.1111/anae.12918 [7] Goddard AF, James MW, McIntyre AS, et al. British Society of Gastroenterology. Guidelines for the management of iron deficiency anaemia[J].Gut, 2011, 60:1309-1316. doi: 10.1136/gut.2010.228874 [8] Pascual M, Bohle B, Alonso S, et al. Preoperative administration of erythropoietin stimulates tumor recurrence after surgical excision of colon cancer in mice by a vascular endothelial growth factor[J]. J Surg Res, 2013, 183:270-277. doi: 10.1016/j.jss.2012.12.041 [9] Ashworth A, Klein A. Cell salvage as part of a blood conservation strategy in anaesthesia[J]. Br J Anaesth, 2010, 105:401-416. doi: 10.1093/bja/aeq244 [10] Feltracco P, Michieletto E, Barbieri S, et al. Microbiologic contamination of intraoperative blood salvaged during liver transplantation[J]. Transplant Proc, 2007, 39:1889-1891. doi: 10.1016/j.transproceed.2007.05.005 [11] Bowley DM, Barker P, Boffard KD. Intraoperative blood salvage in penetrating abdominal trauma:a randomized, controlled trial[J]. World J Surg, 2006, 30:1074-1080. doi: 10.1007/s00268-005-0466-2 [12] Mirhashemi R, Averette HE, Deepika K, et al. The impact of intraoperative autologous blood transfusion during type Ⅲ radical hysterectomy for early-stage cervical cancer[J]. Am J Obstet Gynecol, 1999, 181:1310-1315, 1315-1316. doi: 10.1016/S0002-9378(99)70369-8 [13] Connor JP, Morris PC, Alagoz T, et al. Intraoperative autologous blood collection and autotransfusion in the surgical management of early cancers of the uterine cervix[J]. Obstet Gynecol, 1995, 86:373-378. doi: 10.1016/0029-7844(95)00183-R [14] Bowley DM, Barker P, Boffard KD. Intraoperative blood salvage in penetrating abdominal trauma:a randomised, controlled trial[J]. World J Surg, 2006, 30:1074-1080. doi: 10.1007/s00268-005-0466-2 [15] Henry DA, Carless PA, Moxey AJ, et al. Anti-fibrinolytic use for minimizing perioperative allogeneic blood transfusion[J]. Cochrane Database Syst Rev, 2011, 3:CD001886. http://ceaccp.oxfordjournals.org/external-ref?access_num=17943760&link_type=MED [16] Richman JM, Rowlingson AJ, Maine DN, et al. Does neuraxial anesthesia reduce intraoperative blood loss? A meta-analysis[J]. J Clin Anesth, 2006, 18:427-435. doi: 10.1016/j.jclinane.2006.02.006 [17] Rajagopalan S, Mascha E, Na J, et al. The effects of mild perioperative hypothermia on blood loss and transfusion requirement[J]. Anesthesiology, 2008, 108:71-77. doi: 10.1097/01.anes.0000296719.73450.52 [18] Clevenger B, Mallett S, Klein A, et al. Patient blood management to reduce surgical risk[J]. Br J Surg, 2015, 102:1325-1337. doi: 10.1002/bjs.9898 [19] Meyer AS, Meyer MA, Sørensen AM, et al. Thrombelasto-graphy and rotational thromboelastometry early amplitudes in 182 trauma patients with clinical suspicion of severe injury[J]. J Trauma Acute Care Surg, 2014, 76:682-690. doi: 10.1097/TA.0000000000000134 -
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