Mercer K G, Spark J I, Berridge D C, Kent P J, Scott D J A
Department of Vascular and Endovascular Surgery, Lincoln Wing, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK.
Br J Surg. 2004 Nov;91(11):1443-8. doi: 10.1002/bjs.4793.
Perioperative homologous blood transfusion (HBT) is associated with adverse reactions and risks transmission of infection. It has also been implicated as an immunosuppressive agent. Intraoperative autotransfusion (IAT) is a potential method of autologous transfusion.
This was a single-centre randomized clinical trial of IAT in surgery for abdominal aortic aneurysm. Forty patients were randomized to IAT and 41 underwent surgery with HBT only. Patients in both groups received HBT to maintain haemoglobin levels above 8 g/dl. Transfusion requirements, and incidence of systemic inflammatory response syndrome (SIRS) and infection, were compared.
Significantly fewer patients in the IAT group required HBT (21 versus 31; P = 0.038) and the median blood requirement per patient was 2 units lower (P = 0.012). There was a higher incidence of chest infection (12 versus four patients; P = 0.049) and SIRS (20 versus nine patients; P = 0.020) in the HBT group. Risk of SIRS was related to aortic cross-clamp time in the IAT group only.
Use of autotransfusion effectively reduced the need for HBT and was associated with a reduced incidence of postoperative SIRS and infective complications.
围手术期同种异体输血（HBT）与不良反应及感染传播风险相关。它还被认为是一种免疫抑制剂。术中自体输血（IAT）是一种潜在的自体输血方法。
这是一项关于腹主动脉瘤手术中IAT的单中心随机临床试验。40例患者被随机分配至IAT组，41例仅接受HBT手术。两组患者均接受HBT以维持血红蛋白水平高于8 g/dl。比较输血需求以及全身炎症反应综合征（SIRS）和感染的发生率。
IAT组需要HBT的患者明显更少（21例对31例；P = 0.038），且每位患者的中位血液需求量低2单位（P = 0.012）。HBT组的肺部感染发生率更高（12例对4例患者；P = 0.049），SIRS发生率也更高（20例对9例患者；P = 0.020）。仅在IAT组中，SIRS风险与主动脉交叉钳夹时间相关。
使用自体输血有效减少了对HBT的需求，并与术后SIRS和感染性并发症发生率降低相关。
