Graham I D, Fergusson D, McAuley L, Laupacis A
Loeb Health Research Institute.
Int J Technol Assess Health Care. 2000 Winter;16(1):228-41. doi: 10.1017/s0266462300161197.
Despite the growing medical and public interest in reducing exposure to allogeneic blood, little is known about the use of alternatives to allogeneic transfusion. This study was conducted to determine the availability of these technologies in Canadian hospitals and was undertaken under the auspices of the International Study of Peri-Operative Transfusion (ISPOT), a 10-country study of the effectiveness of, attitudes toward, and practices related to the use of alternatives to allogeneic transfusion.
A cross-sectional national mail survey of Canadian hospitals with greater than 50 medical/surgical beds. Chiefs of anesthesia, surgery, and the divisions of cardiac, orthopedic, vascular, and urology were initially mailed a brief postcard asking which of seven technologies were used in their center. This was then followed up with a one-page questionnaire asking how frequently the technologies were used, their thoughts on the appropriateness of the use of the technologies, barriers to their greater use, and reasons for nonuse of the technologies.
Response rates to the postcard survey ranged from 70%-98%, depending on the technology and type of surgery, and ranged from 27%-53% for the follow-up questionnaire. All technologies were used most frequently in cardiac surgery. Aprotinin, tranexamic acid, aminocaproic acid, desmopressin, and cell salvage were reported used in over 70% of cardiac surgery centers. Of these, tranexamic acid and cell salvage were the only ones used routinely in some centers. Acute normovolemic hemodilution and erythropoietin were used in 45% and 20% of cardiac centers, respectively. The drugs were used in less than 15% of orthopedic, vascular, and urologic divisions, with the exception of desmopressin in urologic and vascular surgery and aminocaproic acid in urologic surgery. The techniques of cell salvage and acute normovolemic hemodilution were used in 30%-45% of these divisions, with the exception of cell salvage, which was used in less than 15% of urology units. In more than 60% of cases, the technologies were considered to be used "about right," although an important minority felt that they were underused.
In general, alternatives to perioperative allogeneic transfusion were rarely used except in cardiac surgery.
尽管医学界和公众对减少异体输血暴露的关注度日益提高，但对于异体输血替代方法的使用情况却知之甚少。本研究旨在确定这些技术在加拿大医院的可及性，该研究是在国际围手术期输血研究（ISPOT）的支持下进行的，这是一项涉及10个国家的关于异体输血替代方法的有效性、态度及相关实践的研究。
对加拿大拥有超过50张医疗/外科床位的医院进行全国性横断面邮寄调查。最初向麻醉科主任、外科主任以及心脏科、骨科、血管科和泌尿科的科室负责人邮寄了一张简短的明信片，询问他们的中心使用了七种技术中的哪一种。随后跟进了一份单页问卷，询问这些技术的使用频率、对其使用适当性的看法、更多使用的障碍以及不使用这些技术的原因。
明信片调查的回复率在70% - 98%之间，具体取决于技术和手术类型，后续问卷的回复率在27% - 53%之间。所有技术在心脏手术中使用最为频繁。据报告，抑肽酶、氨甲环酸、氨基己酸、去氨加压素和细胞回收技术在超过70%的心脏手术中心使用。其中，氨甲环酸和细胞回收技术是仅有的在一些中心常规使用的技术。急性等容血液稀释和促红细胞生成素分别在45%和20%的心脏中心使用。这些药物在骨科、血管科和泌尿科的使用比例不到15%，但去氨加压素在泌尿科和血管外科以及氨基己酸在泌尿科手术中的使用除外。细胞回收和急性等容血液稀释技术在这些科室的使用比例为30% - 45%，但细胞回收技术在泌尿科的使用比例不到15%。在超过60%的情况下，这些技术被认为使用“大致合适”，尽管有相当一部分人认为它们未得到充分利用。
总体而言，除心脏手术外，围手术期异体输血的替代方法很少使用。
