Henry D A, Henderson K M, Fryer J L, Treloar C J, McGrath K M, Deveridge S F
Faculty of Medicine and Health Sciences, University of Newcastle.
Med J Aust. 2000 Apr 17;172(8):365-9. doi: 10.5694/j.1326-5377.2000.tb124007.x.
To investigate use of interventions to minimise need for perioperative transfusion of allogeneic blood in surgical units in Australia.
Two questionnaire-based surveys of practice.
All hospitals in Australia, 1996-1997.
Survey 1: all Australian hospitals that have at least 50 beds and undertake surgery; Survey 2: surgical units identified as using the interventions.
Reported rates of use of the various interventions (preoperative autologous donation, acute normovolaemic haemodilution [ANH], cell salvage, and drugs); use of guidelines; and perceptions about the appropriateness of current levels of use.
Survey 1 was returned by 349 of 400 hospitals (87%) and Survey 2 by 324 of 578 surgical units (56%). Preoperative autologous donation was most widely used (70% of hospitals), most commonly in units performing orthopaedic or vascular surgery (65% and 37%, respectively). Cell salvage and ANH were used by 27% and 24% of hospitals, respectively, most often in units performing cardiothoracic (40% and 44%, respectively) and vascular surgery (29% and 15%, respectively). These three interventions were used significantly more in private than in public hospitals (P < 0.05). Use of printed guidelines was uncommon. Respondents considered that autologous transfusion techniques should be used more widely because of their perceived efficacy and concerns about safety of allogeneic blood. Perceived barriers to greater use included lack of surgeon or physician interest, uncertain scheduling of surgery in public hospitals and cost (cell salvage). Drugs to minimise blood loss were used by fewer than 10% of hospitals.
Interventions to minimise the need for perioperative allogeneic blood transfusion (apart from drugs) are widely used in Australia. However, enthusiasm for intraoperative techniques of re-infusing autologous blood needs to be assessed against the evidence of their efficacy and cost-effectiveness.
调查澳大利亚外科病房为减少围手术期异体输血需求而采取的干预措施的使用情况。
两项基于问卷调查的实践研究。
1996 - 1997年澳大利亚所有医院。
调查1：所有床位至少50张且开展手术的澳大利亚医院；调查2：被确定采用这些干预措施的外科病房。
报告的各种干预措施（术前自体血捐献、急性等容血液稀释[ANH]、细胞回收和药物）的使用率；指南的使用情况；以及对当前使用水平适当性的看法。
400家医院中的349家（87%）回复了调查1，578个外科病房中的324个（56%）回复了调查2。术前自体血捐献使用最为广泛（70%的医院），最常用于进行骨科或血管外科手术的科室（分别为65%和37%）。细胞回收和ANH分别被27%和24%的医院使用，最常用于进行心胸外科手术（分别为40%和44%）和血管外科手术（分别为29%和15%）的科室。这三种干预措施在私立医院的使用显著多于公立医院（P < 0.05）。使用印刷指南的情况并不常见。受访者认为，由于自体输血技术的有效性以及对异体血安全性的担忧，自体输血技术应得到更广泛的应用。认为阻碍其更广泛使用的因素包括外科医生或内科医生缺乏兴趣、公立医院手术安排不确定以及成本（细胞回收）。使用减少失血药物的医院不到10%。
在澳大利亚，为减少围手术期异体输血需求而采取的干预措施（药物除外）被广泛使用。然而，对于术中回输自体血技术的热情，需要根据其有效性和成本效益的证据进行评估。
