Gombotz H, Gries M, Sipurzynski S, Fruhwald S, Rehak P
Department of Anaesthesiology and Intensive Care Medicine, University of Graz, Austria.
Acta Anaesthesiol Scand. 2000 Jul;44(6):737-42. doi: 10.1034/j.1399-6576.2000.440613.x.
Controversy exists about the advantages of predeposit of autologous blood (PDAB), and whether more comfortable blood conservation regimens may yield comparable results. To test the hypothesis that preoperative treatment with recombinant human erythropoietin (rHuEPO) with or without acute concomitant normovolaemic haemodilution (ANHD) is as effective as PDAB in reducing allogeneic blood transfusions, we conducted a prospective randomised study in women undergoing primary hip replacement.
Sixty consecutive female patients scheduled for primary hip replacement and suitable for PDAB were randomly assigned to one of 3 groups. Group I (EPO) and II (ANHD) received 600 U/kg rHuEPO s.c. and 100 mg iron saccharate i.v. on day 14 and, if needed, on day 7 before surgery. Additionally, in group II acute normovolaemic haemodilution (ANHD) was implemented after induction of anaesthesia. In group III (PDAB) conventional PDAB up to 3 U, without volume replacement but with concomitant oral iron therapy, was performed starting 4 weeks before surgery.
The blood conservation methods resulted in a comparable net gain of red cells in all 3 groups until the day of surgery. Because of the withdrawal of autologous blood, haemoglobin values before surgery were lower in the PDAB group than in the EPO and ANHD groups, and during surgery were lower in the PDAB and ANHD groups than in the rHuEPO-only group. Applying moderate ANHD in conjunction with preoperative rHuEPO treatment did not yield an incremental decrease in allogeneic transfusions. There was no difference between the groups in the number of patients who received allogeneic transfusions or in the total number of allogeneic units transfused.
Withdrawal of autologous blood is associated with lower pre- and intraoperative haemoglobin levels when compared to preoperative augmentation of red cell mass using rHu-EPO. As a measure to reduce allogeneic transfusion requirements, preoperative treatment with rHuEPO may be as effective as standard predeposit of autologous blood in women undergoing primary hip replacement, but requires less preoperative time.
对于自体血预存（PDAB）的优势以及更舒适的血液保护方案是否能产生可比结果存在争议。为了验证术前使用重组人促红细胞生成素（rHuEPO）联合或不联合急性等容血液稀释（ANHD）与PDAB在减少异体输血方面同样有效的假设，我们对接受初次髋关节置换术的女性患者进行了一项前瞻性随机研究。
连续60例计划进行初次髋关节置换术且适合PDAB的女性患者被随机分为3组。第一组（EPO组）和第二组（ANHD组）在术前14天，必要时在术前7天，皮下注射600 U/kg rHuEPO及静脉注射100 mg蔗糖铁。此外，第二组在麻醉诱导后进行急性等容血液稀释（ANHD）。第三组（PDAB组）从术前4周开始进行常规PDAB，最多3单位，不进行容量替代，但同时进行口服铁剂治疗。
在手术当天之前，所有3组的血液保护方法导致红细胞净增加量相当。由于自体血的回输，PDAB组术前血红蛋白值低于EPO组和ANHD组，手术期间PDAB组和ANHD组的血红蛋白值低于仅使用rHuEPO组。术前rHuEPO治疗联合适度ANHD并未使异体输血进一步减少。接受异体输血的患者数量或异体输血的总单位数在各组之间无差异。
与术前使用rHu-EPO增加红细胞量相比，自体血回输与较低的术前和术中血红蛋白水平相关。作为减少异体输血需求的一种措施，术前使用rHuEPO在接受初次髋关节置换术的女性中可能与标准的自体血预存同样有效，但所需术前时间更少。
