Shander A
Department of Anesthesia and Intensive Care, Englewood Hospital, NJ 07831, USA.
Zentralbl Chir. 2003 Jun;128(6):468-71. doi: 10.1055/s-2003-40619.
Current data demonstrate a lack of support for allogeneic transfusion as a reliable means of delivering oxygen. For the ICU patient tolerance of anemia along with aggressive erythropoitin plus iron therapies can restore hemoglobin levels to normal earlier and with fewer morbidities and possibly enhanced survival than by allogeneic transfusion. Additional evidence on anemia treatment comes from case report studies where transfusions are prohibited and patients survived extremely low hemoglobin levels. While synthetic and bioengineered temporary oxygen carriers may soon be approved for clinical use, the current treatment of anemia remains permissive for the conscientious and informed physician. In the past, anemia meant an almost mandatory transfusion. Now, evidence provides the clinician with sufficient alternatives to treat anemic patients without the use of bank blood products at lower costs with excellent survival and with evidence accumulating to suggest better outcomes.
目前的数据表明，异体输血作为一种可靠的输氧方式缺乏依据。对于重症监护病房（ICU）的患者，耐受贫血并联合积极的促红细胞生成素加铁剂治疗，与异体输血相比，可更早地将血红蛋白水平恢复正常，且发病率更低，甚至可能提高生存率。关于贫血治疗的更多证据来自病例报告研究，这些研究禁止输血，而患者在血红蛋白水平极低的情况下存活了下来。虽然合成和生物工程临时氧载体可能很快会被批准用于临床，但目前对于谨慎且了解情况的医生而言，贫血治疗仍可采取宽松策略。过去，贫血几乎意味着必须输血。现在，有证据为临床医生提供了足够的替代方案，可在不使用库存血液制品的情况下，以更低的成本治疗贫血患者，患者生存率良好，且越来越多的证据表明治疗效果更佳。
