Snyder-Ramos Stephanie A, Möhnle Patrick, Weng Yi-Shin, Böttiger Bernd W, Kulier Alexander, Levin Jack, Mangano Dennis T
Department of Anesthesiology, University of Heidelberg, Heidelberg, Germany.
Transfusion. 2008 Jul;48(7):1284-99. doi: 10.1111/j.1537-2995.2008.01666.x. Epub 2008 Apr 14.
Although blood utilization has been under considerable scrutiny for the past two decades, particularly for surgery, studies comparing perioperative blood transfusion practices between countries are rare, and the evolution of international standards remains unknown. Therefore, the objective of this evaluation was to compare the perioperative transfusion of blood components in cardiac surgery in multiple centers in different countries.
Transfusion practice was investigated prospectively in 70 centers among 16 countries. A total of 5065 randomly selected cardiac surgery patients of the Multicenter Study of Perioperative Ischemia Epidemiology II (EPI II) Study were evaluated. Utilization of red blood cells (RBCs), fresh-frozen plasma (FFP), and platelets (PLTs) was assessed daily, before, during, and after surgery until hospital discharge.
Intraoperative RBC transfusion varied from 9 to 100 percent among the 16 countries, and 25 to 87 percent postoperatively (percentage of transfused patients). Similarly, frequency of transfusion of FFP varied from 0 to 98 percent intraoperatively and 3 to 95 percent postoperatively, and PLT transfusion from 0 to 51 and 0 to 39 percent, respectively. Moreover, there were not only marked differences in transfusion rates between centers in different countries but also in interinstitutional comparison of multiple centers within countries.
In cardiac surgical patients, marked variability in transfusion practice exists between centers in various countries and suggests differences in perioperative practice patterns as well as possible inappropriate use. International standardization of perioperative practice patterns as well as transfusion regimes appears necessary.
尽管在过去二十年中血液利用情况受到了相当多的审查,尤其是在外科手术方面,但比较不同国家围手术期输血实践的研究很少,国际标准的演变情况仍不为人知。因此,本评估的目的是比较不同国家多个中心心脏手术中围手术期血液成分的输注情况。
对16个国家的70个中心进行了前瞻性输血实践调查。对围手术期缺血流行病学多中心研究II(EPI II)中随机选取的5065例心脏手术患者进行了评估。每天评估红细胞(RBC)、新鲜冰冻血浆(FFP)和血小板(PLT)在手术前、手术期间和手术后直至出院的使用情况。
16个国家术中RBC输注率在9%至100%之间,术后为25%至87%(输血患者的百分比)。同样,FFP术中输注频率在0%至98%之间,术后为3%至95%,PLT输注频率分别为0%至51%和0%至39%。此外,不同国家中心之间的输血率不仅存在显著差异,而且同一国家内多个中心的机构间比较也存在差异。
在心脏手术患者中,不同国家的中心之间输血实践存在显著差异,这表明围手术期实践模式存在差异,也可能存在不适当的使用情况。围手术期实践模式以及输血方案的国际标准化似乎很有必要。