Dahlmann H, Schwarz C, Kasper M, Zech D
Institut für Anaesthesiologie und Operative Intensivmedizin, Universität zu Köln.
Z Orthop Ihre Grenzgeb. 1991 Mar-Apr;129(2):174-7. doi: 10.1055/s-2008-1040178.
The records of a total of 102 patients who underwent primary total hip replacement during 1987-88 were evaluated retrospectively. 36 patients had donated 1-3 units of whole blood preoperatively. Surgery was performed with the use of a device for intraoperative autotransfusion (IAT). Another 25 patients without preoperative autologous blood donation were operated with the use of IAT. None of these techniques was available for the remaining 41 patients. The mean perioperative blood loss and the mean volume of transfused blood were 1400 ml and 1000 ml respectively. Equal quantities of blood were lost intra- and postoperatively, whereas only one fifth of transfused blood was given intraoperatively. Homologous blood transfusion was not required in 32% of the patients for whom autologous blood was not available. However after preoperative autologous blood donation, 95% of the 2-unit donors and 100% of the 3-unit donors could be operated without homologous blood transfusion. Autologous blood donation did not increase the need for homologous blood transfusions. With the use of IAT it was only 20% of the patients that at least 500 ml of blood were salvaged for retransfusion. On the basis of these findings, elective primary total hip replacement would seem to be the ideal operation to be performed after preoperative autologous blood donation and, whenever possible with the use of IAT. The desirable ratio of 1,5:1 for the units of blood to be crossmatched preoperatively vs. units transfused perioperatively can be achieved solely by preoperative donation of 3 units of autologous blood.
回顾性评估了1987年至1988年期间接受初次全髋关节置换术的102例患者的记录。36例患者术前捐献了1 - 3单位全血。手术使用了术中自体输血（IAT）设备。另外25例未进行术前自体血捐献的患者也使用IAT进行了手术。其余41例患者无法使用这些技术中的任何一种。围手术期平均失血量和平均输血量分别为1400毫升和1000毫升。术中和术后失血量相等，而术中输注的血液仅占输注总量的五分之一。32%无法获得自体血的患者不需要输注异体血。然而，在术前进行自体血捐献后，2单位献血者中有95%以及3单位献血者中有100%可以在不输注异体血的情况下进行手术。自体血捐献并未增加对异体血输血的需求。使用IAT时，只有20%的患者至少回输了500毫升血液。基于这些发现，择期初次全髋关节置换术似乎是术前自体血捐献后进行的理想手术，并且只要有可能应使用IAT。术前交叉配血的单位与围手术期输注单位的理想比例1.5:1仅通过术前捐献3单位自体血即可实现。
