Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR, USA.
Otolaryngol Head Neck Surg. 2010 Mar;142(3):359-64. doi: 10.1016/j.otohns.2009.11.024. Epub 2010 Jan 22.
The ideal hematocrit for patients undergoing free flap reconstruction is unknown. It is standard practice to keep hematocrit levels above 30 percent, although there is evidence that blood transfusions are associated with both infectious and noninfectious complications. We propose that lowering the trigger for postoperative transfusions from 30 percent to 25 percent will not increase flap-related complications and may reduce unnecessary blood transfusions.
Observational cohort study.
Tertiary care center.
Patients undergoing free tissue transfer from January 2007 through February 2008 received blood transfusions for hematocrit < 30 percent, whereas patients having surgery from March 2008 through April 2009 received blood transfusions for hematocrit < 25 percent. Outcomes include flap-related complications, length of stay, number of units transfused, and lowest postoperative hematocrit.
In the group transfused for hematocrit < 30 percent, 123 patients underwent 129 free flaps. In the group transfused for hematocrit < 25 percent, 122 patients underwent 135 flaps. The mean lowest postoperative hematocrit levels were significantly lower in the group transfused for hematocrit < 25 percent compared with the group transfused for hematocrit < 30 percent (26.6% vs 28.4%, respectively, P < 0.0001). The group with hematocrit < 25 percent also received fewer units of blood transfused (1.47 vs 2.11, P = 0.028). Complication rates between the two groups were not significantly different aside from higher rates of fistula and respiratory failure in the group transfused for hematocrit < 30 percent. Flap loss was 2.3 percent compared with 6.7 percent (P = 0.138).
For patients undergoing free flap surgery, a postoperative transfusion trigger of hematocrit < 25 percent decreases blood transfusion rates without increasing rates of flap-related complications.
接受游离皮瓣重建的患者的理想血细胞比容值尚不清楚。将血细胞比容维持在 30%以上是标准做法，尽管有证据表明输血与感染和非感染并发症都有关。我们提出，将术后输血的触发阈值从 30%降低到 25%不会增加皮瓣相关并发症，并且可能减少不必要的输血。
观察性队列研究。
三级护理中心。
2007 年 1 月至 2008 年 2 月期间接受游离组织转移的患者，当血细胞比容<30%时接受输血，而 2008 年 3 月至 2009 年 4 月期间接受手术的患者，当血细胞比容<25%时接受输血。结果包括皮瓣相关并发症、住院时间、输血量和术后最低血细胞比容。
在血细胞比容<30%接受输血的患者中，123 名患者接受了 129 次游离皮瓣转移。在血细胞比容<25%接受输血的患者中，122 名患者接受了 135 次皮瓣转移。与血细胞比容<30%接受输血的患者相比，血细胞比容<25%接受输血的患者术后最低血细胞比容水平显著降低（分别为 26.6%和 28.4%，P<0.0001）。血细胞比容<25%接受输血的患者还输注了更少的单位血液（1.47 比 2.11，P=0.028）。除了血细胞比容<30%接受输血的患者中更高的瘘管和呼吸衰竭发生率外，两组之间的并发症发生率没有显著差异。皮瓣失活率为 2.3%，而 6.7%（P=0.138）。
对于接受游离皮瓣手术的患者，术后输血的血细胞比容<25%触发阈值可降低输血率，而不会增加皮瓣相关并发症的发生率。
