Choy Y C, Lim W L, Ng S H
Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur.
Med J Malaysia. 2007 Oct;62(4):299-302.
The main goal of perioperative transfusion is to reduce the morbidity and mortality associated with inadequate delivery of oxygen to the tissues during surgery. In this audit, the primary trigger for transfusion was clinical anaemia assessed by examination of a patient's conjunctiva [40.7%] followed by estimation of blood loss of greater 20% of total blood volume [29.3%]. Haemoglobin estimation in the operation theater was not done in 45.9% of studied patients and only 7.8% patients had transfusion based on this criteria. A common practice is to transfuse blood for hypovolaemia. This was the indication for blood transfusion in 96 patients (7.8%). Inappropriate use of blood in this way has led to wastage of a valuable resource and exposed patients to potential risks of unwanted side effects. Analysis of haemoglobin estimation at recovery room showed 32% of patient with co-morbidities had Hb > 10 gm% while 65% and 29.5% of patients without co-morbidities had Hb > 8 gm% and 10 gm% respectively. This reflects the practice of anaesthetists in maintaining a target of Hb of 10 gm% for both groups of patients while a target of 8 gm% is still relatively safe for patients with good cardiovascular reserves. This has resulted in signifant use of homologous blood which will certainly burden the blood bank and increase the cost of healthcare.
围手术期输血的主要目标是降低与手术期间组织氧输送不足相关的发病率和死亡率。在本次审计中，输血的主要触发因素是通过检查患者结膜评估的临床贫血（40.7%），其次是估计失血量超过总血容量的20%（29.3%）。在45.9%的研究患者中未在手术室进行血红蛋白估计，只有7.8%的患者基于此标准进行输血。一种常见的做法是为低血容量患者输血。这是96例患者（7.8%）输血的指征。以这种方式不恰当使用血液导致了宝贵资源的浪费，并使患者面临不必要副作用的潜在风险。对恢复室血红蛋白估计的分析显示，32%的合并症患者血红蛋白>10g%，而无合并症患者中分别有65%和29.5%的患者血红蛋白>8g%和10g%。这反映了麻醉医生对两组患者都维持血红蛋白目标为10g%的做法，而对于心血管储备良好的患者，目标为8g%仍然相对安全。这导致了大量使用同源血，这肯定会给血库带来负担并增加医疗保健成本。
