Chang Sam S, Duong David T, Wells Nancy, Cole Emily E, Smith Joseph A, Cookson Michael S
Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2765, USA.
J Urol. 2004 May;171(5):1861-5. doi: 10.1097/01.ju.0000120441.96995.e3.
Radical retropubic prostatectomy (RRP) has been associated with significant blood loss and/or transfusion requirement. While still a concern, routine autologous blood donation has not been standard at our institution for more than a decade. We assessed recent blood loss and transfusion requirements in contemporary patients undergoing RRP and examined the possible predictive impact of preoperative variables.
A retrospective review of 436 consecutive patients who underwent RRP between July 1999 and December 2001 was performed with the primary purpose of analyzing estimated blood loss (EBL) and blood transfusion requirements as well as possible preoperative risk factors, including clinical demographic characteristics, body mass index (BMI), defined as weight in kg/height in m, comorbidities, American Society of Anesthesiologists classification and Charlson index score.
A total of 436 consecutive patients with a mean age of 60 years (range 39 to 78) underwent RRP under general anesthesia. Mean American Society of Anesthesiologists class was 2.3 (range 1 to 3) and the mean BMI was 27.7 (range 18.2 to 44.3). Mean preoperative and postoperative hematocrit was 43.9% and 32.5%, respectively. Overall mean EBL was 603 cc (range 100 to 3500) and the transfusion rate was 4.8%. On multivariate analysis the only significant correlative predictor of EBL was BMI. There was a significantly lower EBL in patients with an acceptable BMI (less than 25) vs overweight (25 to 30) and obese (greater than 30) patients (p = 0.021). Likewise the rate of transfusion was significantly higher in the overweight (6.9%) and obese (5.6%) groups compared to the normal BMI group (1.9%) (p = 0.009).
Our series demonstrates that blood loss during RRP continues to decrease. The respectable blood loss and low transfusion rates in this series were due to refinements in surgical technique rather than to perioperative modifications. To our knowledge the identification of BMI as a predictor of blood loss and transfusion is novel. These data serve as a benchmark for future comparisons and argue for continued refinements in techniques to decrease blood loss, particularly in overweight and obese patients.
耻骨后根治性前列腺切除术（RRP）常伴有大量失血和/或输血需求。尽管这仍是一个值得关注的问题，但在我们机构，常规自体血捐献已十多年未成为标准做法。我们评估了当代接受RRP患者近期的失血情况和输血需求，并研究了术前变量可能产生的预测影响。
对1999年7月至2001年12月期间连续436例行RRP的患者进行回顾性研究，主要目的是分析估计失血量（EBL）、输血需求以及可能的术前危险因素，包括临床人口统计学特征、体重指数（BMI，定义为体重（千克）除以身高（米）的平方）、合并症、美国麻醉医师协会分级和查尔森指数评分。
共有436例连续患者，平均年龄60岁（范围39至78岁），在全身麻醉下接受了RRP。美国麻醉医师协会平均分级为2.3（范围1至3），平均BMI为27.7（范围18.2至44.3）。术前和术后平均血细胞比容分别为43.9%和32.5%。总体平均EBL为603毫升（范围100至3500），输血率为4.8%。多因素分析显示，EBL唯一显著的相关预测因素是BMI。BMI正常（小于25）的患者与超重（25至30）和肥胖（大于30）患者相比，EBL显著更低（p = 0.021）。同样，超重（6.9%）和肥胖（5.6%）组的输血率显著高于正常BMI组（1.9%）（p = 0.009）。
我们的系列研究表明，RRP术中的失血量持续减少。本系列中可观的失血量和低输血率归因于手术技术的改进，而非围手术期的调整。据我们所知，将BMI确定为失血和输血的预测指标是新颖的。这些数据可作为未来比较的基准，并支持持续改进技术以减少失血，特别是在超重和肥胖患者中。
