Borghi B, Casati A
Department of Anaesthesiology, IRCCS Rizzoli Orthopaedic Institute, Bologna and Department of Anaesthesiology, IRCCS H San Raffaele, Via Olgettina 60-20132 Milan, Italy.
Eur J Anaesthesiol. 2000 Jul;17(7):411-7. doi: 10.1046/j.1365-2346.2000.00693.x.
The efficacy of an integrated autotransfusion regimen, including pre-donation and perioperative salvage of autologous blood, was prospectively evaluated in 2884 patients undergoing total hip (n = 2016) or knee arthroplasty (n = 480), and hip revision (n = 388) with either balanced general, regional, or integrated epidural/general anaesthesia. Allogenic concentrated red blood cells were transfused in the presence of symptomatic anaemia or when haemoglobin concentration was < 6 g dL-1 (10 g dL-1 in patients affected by cerebrovascular or coronary artery disease) after all salvaged and pre-donated autologous blood had been transfused. A total of 278 patients (9.6%) received allogenic blood. Risk factors for allogenic blood transfusion were: preoperative haemoglobin concentration < 10 g dL-1 (after autologous blood pre-donations) (Odds ratio: 8.7; 95% CI: 6.5-16.8; P = 0.004), hip revision versus hip or knee arthroplasty (Odds ratio: 5.8; 95% CI: 3.9-8.5; P = 0. 0001) and inability in obtaining the number of pre-donations required by the Maximum Surgery Blood Order on Schedule (Odds ratio: 3.4; 95% CI: 2.7-4.1; P = 0.0001). The incidence of perioperative complications, including wound infection and haematoma, as well as myocardial ischaemia, respiratory failure and thromboembolic complications, was higher in those patients requiring allogenic blood transfusion (29.8%) than that observed in patients receiving only autologous blood (6.6%) (P = 0.0005); while the mean time duration from surgical procedure to patient discharge from the orthopaedic ward was shorter in those patients not receiving allogenic blood transfusion (12 days; 25-75th percentiles: 8-14 days) than in those patients who required perioperative transfusion with allogenic blood (15 days; 25-75th percentiles: 10-17 days) (P = 0.0005). In conclusion, this prospective study highlighted the clinical relevance of applying an extensive and integrated autotransfusion regimen in order to reduce allogenic blood transfusion and associated complications in patients undergoing major joint replacement.
对2884例行全髋关节置换术（n = 2016）、膝关节置换术（n = 480）或髋关节翻修术（n = 388）的患者，前瞻性评估了一种综合自体输血方案的疗效，这些患者接受平衡全身麻醉、区域麻醉或硬膜外/全身联合麻醉。在输注所有回收的自体血和预先采集的自体血后，若出现症状性贫血或血红蛋白浓度< 6 g/dL（脑血管或冠状动脉疾病患者为< 10 g/dL），则输注异体浓缩红细胞。共有278例患者（9.6%）接受了异体输血。异体输血的危险因素包括：术前血红蛋白浓度< 10 g/dL（自体血预先采集后）（比值比：8.7；95%置信区间：6.5 - 16.8；P = 0.004），髋关节翻修术与髋关节或膝关节置换术相比（比值比：5.8；95%置信区间：3.9 - 8.5；P = 0.0001），以及无法按《最大手术用血预定计划》获得所需的预先采集血量（比值比：3.4；95%置信区间：2.7 - 4.1；P = 0.0001）。需要异体输血的患者围手术期并发症的发生率，包括伤口感染、血肿以及心肌缺血、呼吸衰竭和血栓栓塞并发症，高于仅接受自体输血的患者（29.8%对6.6%）（P = 0.0005）；而未接受异体输血的患者从手术到从骨科病房出院的平均时间较短（12天；第25 - 75百分位数：8 - 14天），短于需要围手术期异体输血的患者（15天；第25 - 75百分位数：10 - 17天）（P = 0.0005）。总之，这项前瞻性研究强调了应用广泛的综合自体输血方案对于减少接受大关节置换术患者的异体输血及相关并发症的临床意义。
