Lippi G, Montagnana M, Mattiuzzi C, Franchini M, Alberti V, Guidi G C
Unità di Chimica e Microscopia Clinica, Dipartimento di Scienze Morfologico-Biomediche, Università degli Studi di Verona, Verona, Italy.
Minerva Med. 2005 Dec;96(6):397-407.
The preoperative laboratory screening is commonplace in clinical practice and is traditionally defined as the practice of prescribing laboratory testing before surgery on patients undergoing a given procedure. The wide heterogeneity of the solutions prospected over the past decades emphasizes the objective difficulty at issuing definitive guidelines and recommendations. Despite its widespread use, a systematic evaluation of the clinical and cost-effectiveness of routine laboratory testing demonstrates that several approaches are as yet unsuitable, as inappropriate investigations may lead to evaluation of borderline or false-positive laboratory abnormalities. Three major difficulties can be identified when issuing reliable recommendations: articulation and appropriateness of diagnostic protocols, contestualization, in terms of surgical procedures and suitable clinical contests that might achieve the greatest advantages from results of laboratory testing, and impact of these tests on clinical management and outcome. This article aims to provide a comprehensive review of the current literature on this topic, attempting to suggest a suitable approach to the puzzling issue of preoperative laboratory testing.
术前实验室筛查在临床实践中很常见，传统上被定义为对接受特定手术的患者在手术前进行实验室检查的做法。在过去几十年中提出的解决方案存在广泛的异质性，这凸显了制定明确指南和建议的客观困难。尽管术前实验室筛查被广泛使用，但对常规实验室检查的临床和成本效益进行的系统评估表明，几种方法目前并不适用，因为不适当的检查可能会导致对临界或假阳性实验室异常情况的评估。在发布可靠建议时，可以确定三个主要困难：诊断方案的明确性和适当性、根据手术程序和可能从实验室检查结果中获得最大益处的合适临床情况进行情境化，以及这些检查对临床管理和结果的影响。本文旨在对关于该主题的当前文献进行全面综述，试图为术前实验室检查这一令人困惑的问题提出一种合适的方法。
