用于耻骨后根治性前列腺切除术和根治性膀胱切除术的急性等容血液稀释

Acute normovolemic hemodilution for radical retropubic prostatectomy and radical cystectomy.

作者信息

Takayanagi Akio, Masumori Naoya, Kobayashi Ko, Kunishima Yasuharu, Takahashi Atsushi, Itoh Naoki, Yamakage Michiaki, Namiki Masayoshi, Tsukamoto Taiji

机构信息

Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan.

出版信息

Urology. 2008 Aug;72(2):401-5. doi: 10.1016/j.urology.2007.11.006. Epub 2008 Mar 4.

DOI:10.1016/j.urology.2007.11.006

PMID:18295317

Abstract

OBJECTIVES

Radical retropubic prostatectomy (RRP) and radical cystectomy (RCx) are well tolerated and widely performed. Because intraoperative blood loss is one of the most common problems, we performed acute normovolemic hemodilution (ANH) to prevent allogenic blood transfusion (ABT). In this study we tried to clarify the safety, effectiveness and problems of ANH at urologic operations.

METHODS

The study included 169 patients who underwent RRP and 97 patients underwent RCx from April 2003 to March 2006. The eligible patients for ANH were required to have preoperative hemoglobin of 12 g/dL or more without history of myocardial ischemia. The amount of blood collected was 800 mL in RRP and 800 mL or 1200 mL in RCx. Neoadjuvant chemotherapy was performed in 11 (11.3%) of 97 patients with RCx.

RESULTS

ANH was available in 164 (97.0%) of 169 patients in RRP and 41 (42.3%) of 97 patients in RCx. All 11 (11.3%) patients who received neoadjuvant chemotherapy before RCx revealed anemia and all were excluded from ANH. No patients had an hypovolemic event develop during the autologous blood being stored. The median volume of intraoperative blood loss was 1400 mL in 164 RRP and 19 patients (11.6%) required ABT. In 41 patients undergoing RCx, the median volume of blood loss was 1720 mL and 13 patients (32.5%) required ABT. In the postoperative period, no patients had cardiovascular or pulmonary complications develop originated from ANH.

CONCLUSIONS

ANH is a safe and useful method of transfusion during RRP and RCx. ANH can be recommended for patients who need these operations.

摘要

目的

耻骨后根治性前列腺切除术（RRP）和根治性膀胱切除术（RCx）耐受性良好且广泛开展。由于术中失血是最常见的问题之一，我们采用急性等容血液稀释（ANH）来预防异体输血（ABT）。在本研究中，我们试图阐明泌尿外科手术中ANH的安全性、有效性及问题。

方法

本研究纳入了2003年4月至2006年3月期间接受RRP的169例患者和接受RCx的97例患者。符合ANH条件的患者术前血红蛋白需达12 g/dL或更高且无心肌缺血病史。RRP中采集的血量为800 mL，RCx中采集的血量为800 mL或1200 mL。97例RCx患者中有11例（11.3%）接受了新辅助化疗。

结果

RRP的169例患者中有164例（97.0%）可进行ANH，RCx的97例患者中有41例（42.3%）可进行ANH。所有11例（11.3%）在RCx前接受新辅助化疗的患者均出现贫血，均被排除在ANH之外。自体血储存期间无患者发生低血容量事件。164例RRP患者术中失血量中位数为1400 mL，19例（11.6%）患者需要ABT。41例接受RCx的患者中，失血量中位数为1720 mL，13例（32.5%）患者需要ABT。术后，无患者发生源于ANH的心血管或肺部并发症。