Habler O, Meier J, Pape A, Kertscho H, Zwissler B
Klinik für Anästhesiologie, Operative Intensivmedizin und Schmerztherapie, Krankenhaus Nordwest GmbH, Steinbacher Hohl 2-26, 60488 Frankfurt a.M.
Urologe A. 2007 May;46(5):W543-56; quiz W557-8. doi: 10.1007/s00120-007-1344-3.
The expected cost explosion in transfusion medicine increases the socio-economic significance of specific institutional transfusion programs. In this context the estimated use of the patient's physiologic tolerance represents an integral part of any blood conservation concept. The present article summarizes the mechanisms, influencing factors and limits of this natural tolerance to anemia and deduces the indication for perioperative red blood cell transfusion. The current recommendations coincide to the effect that perioperative transfusion is unnecessary up to a Hb concentration of 10 g/dl (6.21 mmol/l) even in older patients with cardiopulmonary comorbidity and is only recommended in cases of Hb <6 g/dl (<3.72 mmol/l) in otherwise healthy subjects including pregnant women and children. Critically ill patients with multiple trauma and sepsis do not seem to benefit from transfusions up to Hb concentrations >9 g/dl (>5.59 mmol/l). In cases of massive hemorrhaging and diffuse bleeding disorders the maintenance of a Hb concentration of 10 g/dl (6.21 mmol/l) seems to contribute to stabilization of coagulation.
输血医学中预期的成本激增提高了特定机构输血计划的社会经济意义。在此背景下，对患者生理耐受性的评估使用是任何血液保护理念不可或缺的一部分。本文总结了对贫血的这种自然耐受性的机制、影响因素和局限性，并推导了围手术期红细胞输血的指征。目前的建议一致认为，即使是患有心肺合并症的老年患者，血红蛋白浓度达到10 g/dl（6.21 mmol/l）时围手术期输血也是不必要的，只有在包括孕妇和儿童在内的其他健康受试者血红蛋白<6 g/dl（<3.72 mmol/l）的情况下才建议输血。患有多发伤和脓毒症的重症患者，血红蛋白浓度>9 g/dl（>5.59 mmol/l）时输血似乎并无益处。在大出血和弥漫性出血性疾病的情况下，维持血红蛋白浓度10 g/dl（6.21 mmol/l）似乎有助于稳定凝血功能。
