Kohli N, Mallipeddi P K, Neff J M, Sze E H, Roat T W
Division of Urogynecology and Reconstructive Pelvic Surgery, Good Samaritan Hospital, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA.
Obstet Gynecol. 2000 Jun;95(6 Pt 1):847-50. doi: 10.1016/s0029-7844(00)00796-1.
To determine the clinical use and associated costs of routine postoperative hematocrit after elective gynecologic surgery.
We reviewed the charts of all women who had elective gynecologic surgery over 12 months at a community hospital. Demographic data, estimated blood loss at surgery, pre- and postoperative hematocrits, postoperative symptoms suggesting anemia, and incidence of transfusion were tabulated. Laboratory charges for hematocrit at the hospital were used to develop an economic assessment. Statistical analysis was done with Student t test, Mann-Whitney U test, and Fisher exact test.
Among 1105 women who had elective surgery, a single postoperative hematocrit was done in 761 (69%) and two or more postoperative hematocrits (mean 2.4, range 2-6) were done in 201 (18%). The overall incidence of blood transfusion related to elective gynecologic surgery was 1.9% (21 of 1105). Five of those women needed preoperative transfusions, eight needed intraoperative transfusions, and the remaining eight had postoperative transfusions. All women who needed postoperative transfusion showed some sign or symptom of anemia. None received transfusions based solely on hematocrit. Risk factors for postoperative transfusion included low preoperative hematocrit and increased intraoperative blood loss.
Routine postoperative hematocrit in asymptomatic women after uncomplicated elective gynecologic surgery did not improve outcome.
确定择期妇科手术后常规检测术后血细胞比容的临床用途及相关费用。
我们回顾了一家社区医院12个月内所有接受择期妇科手术的女性患者的病历。将人口统计学数据、手术中的估计失血量、术前和术后血细胞比容、提示贫血的术后症状以及输血发生率制成表格。利用医院血细胞比容的实验室收费进行经济评估。采用学生t检验、曼-惠特尼U检验和费舍尔精确检验进行统计分析。
在1105例行择期手术的女性中，761例（69%）进行了单次术后血细胞比容检测，201例（18%）进行了两次或更多次术后血细胞比容检测（平均2.4次，范围2 - 6次）。择期妇科手术相关输血的总体发生率为1.9%（1105例中的21例）。其中5名女性术前需要输血，8名需要术中输血，其余8名术后输血。所有需要术后输血的女性均表现出一些贫血的体征或症状。没有人仅根据血细胞比容接受输血。术后输血的危险因素包括术前血细胞比容低和术中失血量增加。
在无并发症的择期妇科手术后，对无症状女性进行常规术后血细胞比容检测并不能改善预后。
