Olah A, Pasic M, Redaelli C, Carrel T, Laske A, Bauer E, von Segesser L K, Turina M
Klinik für Herz- und Gefässchirurgie, Universitätsspital Zürich.
Helv Chir Acta. 1992 May;58(6):801-4.
To determine the amount of blood substitution required we evaluated in a retrospective analysis 68 consecutive patients that were operated on the infrarenal abdominal aorta 1990, 60 men with a mean age of 66 years (40-87) and 8 women, aged 73 years (62-85). Indications for treatment were: aneurysm (55) and occlusive disease (13). 21 aneurysms (45%) were ruptured and had to be operated as an emergency. Early lethality (less than 30 days) in this group was 19% (n = 4). In the other 47 patients there was no early mortality. Mean blood products transfusion requirements in patients with ruptured abdominal aortic aneurysm was: 18 (9-34) units of concentrated red cells, 16 (3-43) units of fresh frozen plasma (FFP) and 5 (0-19) units of concentrated red cells, 2 (0-7) units of FFP in the elective group. Main determinants of blood loss in the elective group were: the number of anastomoses and the preoperative status of the coagulant system. We conclude that in elective surgery of the infrarenal aorta homologous transfusion can be virtually eliminated if an entire autologous transfusion concepts is applied (predonation, intraoperative salvage, hemodilution and plasmapheresis).
为确定所需的血液置换量，我们进行了一项回顾性分析，评估了1990年连续68例接受肾下腹主动脉手术的患者，其中60例男性，平均年龄66岁（40 - 87岁），8例女性，年龄73岁（62 - 85岁）。治疗指征为：动脉瘤（55例）和闭塞性疾病（13例）。21例动脉瘤（45%）破裂，必须作为急诊手术。该组早期死亡率（小于30天）为19%（n = 4）。在其他47例患者中无早期死亡。腹主动脉瘤破裂患者的平均血液制品输注需求量为：浓缩红细胞18（9 - 34）单位，新鲜冰冻血浆（FFP）16（3 - 43）单位；择期手术组为浓缩红细胞5（0 - 19）单位，FFP 2（0 - 7）单位。择期手术组失血的主要决定因素为：吻合口数量和凝血系统的术前状态。我们得出结论，在肾下腹主动脉择期手术中，如果应用整个自体输血概念（术前预存式自体输血、术中血液回收、血液稀释和血浆置换），同种异体输血几乎可以消除。
