Lutz Jürgen T, Valentín-Gamazo Camino, Görlinger Klaus, Malagó Massimo, Peters Jürgen
Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Essen, Germany.
Anesth Analg. 2003 Feb;96(2):351-5, table of contents. doi: 10.1097/00000539-200302000-00010.
Living related liver donation for liver transplantation in adults including its risks is receiving increased attention. We present data from 44 liver donors focusing on transfusion requirements and avoidance of heterologous transfusion. The volume of blood transfused (both autologous from preoperative donation and heterologous) was assessed including that derived from intraoperative isovolemic hemodilution, cell-saver salvaged, and retransfused blood. Hemoglobin concentration and central venous pressure were measured at specified time points before and during surgery. Intraoperative blood loss was calculated and correlated to the duration of parenchymal transsection, liver volume resected, and central venous pressure. There were no specific anesthesia-evoked complications. In 4 donors, major bleeding (>2000 mL) occurred. Blood loss averaged 902 +/- 564 mL (SD), yielding a minimal mean hemoglobin concentration of 8.1 +/- 1.2 g/dL. One donor received 3 U of heterologous blood and 30 donors received autologous blood from their preoperative donation. An average of 592 +/- 112 mL of blood derived from perioperative acute isovolemic hemodilution was retransfused as was 421 +/- 333 mL of washed red cells from the cell-saving system. Avoidance of heterologous blood transfusion, application of blood-saving techniques, and efficient pain management are crucial for adult living liver donors. Transfusion of banked blood can be avoided in most patients when intraoperative cell salvage, preoperative autologous blood donation, and intraoperative hemodilution are combined.
成人活体肝移植的亲属活体肝捐献及其风险正受到越来越多的关注。我们展示了44例肝供体的数据，重点关注输血需求和避免异体输血。评估了输注的血量（包括术前自体献血和异体输血），其中包括术中等容血液稀释、细胞回收和回输的血液。在手术前和手术期间的特定时间点测量血红蛋白浓度和中心静脉压。计算术中失血量，并将其与实质切开时间、切除的肝脏体积和中心静脉压相关联。未出现特定的麻醉引起的并发症。4例供体发生大出血（>2000 mL）。平均失血量为902±564 mL（标准差），最低平均血红蛋白浓度为8.1±1.2 g/dL。1例供体接受了3单位异体血，30例供体接受了术前自体献血的自体血。围手术期急性等容血液稀释平均回输592±112 mL血液，细胞回收系统回输421±333 mL洗涤红细胞。避免异体输血、应用血液保护技术和有效的疼痛管理对成人活体肝供体至关重要。当术中细胞回收、术前自体献血和术中血液稀释相结合时，大多数患者可以避免输注库存血。
