Sanders G, Mellor N, Rickards K, Rushton A, Christie I, Nicholl J, Copplestone A, Hosie K
Department of Colorectal Surgery, Derriford Hospital, Plymouth, UK.
Br J Anaesth. 2004 Dec;93(6):775-81. doi: 10.1093/bja/aeh279. Epub 2004 Oct 1.
The efficacy of acute normovolaemic haemodilution (ANH) remains uncertain because of a lack of well-designed prospective randomized controlled trials. The aim of this study was to assess the effects of ANH on allogeneic transfusion, postoperative complications, and duration of stay.
Consecutive patients undergoing major gastrointestinal surgery were randomized to a planned 3-unit ANH, or no ANH. Both groups underwent identical management including adherence to a transfusion protocol after surgery. Outcome measures included the number of patients receiving allogeneic blood, complications, and duration of stay.
380 patients were screened of which 160 were included in the study, median age was 62 yr (range 23-90), 'ANH' n=78, 'no ANH' n=82. There was no significant difference between groups in the number of patients receiving allogeneic blood 22/78 (28%) vs 25/82 (30%), the total number of allogeneic units transfused (90 vs 93), complication rate, or duration of stay. Haemodilution significantly increased anaesthetic time, median 55 (range 15-90) vs 40 min (range 17-80) (P<0.001). Significantly fewer patients in the ANH group experienced oliguria in the immediate postoperative period 37/78 (47%) vs 55/82 (67%) (P=0.012). The most significant factors affecting transfusion were blood loss, starting haemoglobin, and age. When compared with ASA-matched historical controls, the introduction of a transfusion protocol reduced the transfusion rate in colorectal patients from 136/333 (41%) to 37/138 (27%), P=0.004.
In this large pragmatic study, ANH did not affect allogeneic transfusion rate in major gastrointestinal surgery. Preoperative haemoglobin, blood loss, and transfusion protocol are the key factors influencing allogeneic transfusion.
由于缺乏设计良好的前瞻性随机对照试验，急性等容性血液稀释（ANH）的疗效仍不确定。本研究的目的是评估ANH对异体输血、术后并发症及住院时间的影响。
连续纳入接受大型胃肠道手术的患者，随机分为计划进行3单位ANH组或不进行ANH组。两组术后均接受相同的管理，包括遵循输血方案。观察指标包括接受异体输血的患者数量、并发症及住院时间。
共筛查380例患者，其中160例纳入研究，中位年龄62岁（范围23 - 90岁），“ANH组”n = 78，“非ANH组”n = 82。两组在接受异体输血的患者数量（22/78，28% 对比 25/82，30%）、异体输血总量（90对比93）、并发症发生率或住院时间方面无显著差异。血液稀释显著延长了麻醉时间，中位时间55分钟（范围15 - 90分钟）对比40分钟（范围17 - 80分钟）（P < 0.001）。ANH组术后即刻少尿的患者明显更少，37/78（47%）对比55/82（67%）（P = 0.012）。影响输血的最主要因素是失血量、起始血红蛋白水平及年龄。与美国麻醉医师协会（ASA）匹配的历史对照相比，采用输血方案使结直肠癌患者的输血率从136/333（41%）降至37/138（27%），P = 0.004。
在这项大型实用性研究中，ANH不影响大型胃肠道手术中的异体输血率。术前血红蛋白水平、失血量及输血方案是影响异体输血的关键因素。
