Long Timothy R, Curry Timothy B, Stemmann Jolene L, Bakken Dixie P, Kennedy April M, Stringer Tia M, Bower Thomas C, Joyner Michael J, Wass C Thomas
Department of Anesthesiology, College of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
Ann Vasc Surg. 2010 May;24(4):447-54. doi: 10.1016/j.avsg.2009.11.009. Epub 2010 Apr 2.
Significant changes in perioperative red blood cell (RBC) transfusion practice during the past two decades have been reported but similar data are not available for patients undergoing abdominal aortic aneurysm (AAA) surgery.
Adult patients who had undergone primary, elective, open AAA repair were stratified into one of two transfusion-related groups: early practice (1980-1982) or late practice (2003-2006). RBC transfusion and hemoglobin concentration (Hb) were analyzed as a continuous variable and compared between groups with use of the rank sum test. Perioperative complications were compared between groups with Fisher's exact test. Data were age adjusted, and analyses were corrected for multiple comparisons.
Compared with the early practice group, patients in the late practice group had significantly lower intraoperative (mean 10 +/- 1.4 vs. 11.5 +/- 1.5 g/dL), postoperative (11.9 +/- 1.4 vs. 13.4 +/- 1.5 g/dL), and discharge Hbs (mean 10.8 +/- 1.2 vs. 12.5 +/- 1.5 g/dL) (p < 0.0001 for each variable). Patients in the late practice group were significantly less likely to receive intraoperative allogenic transfusions (46% vs. 99%, p < 0.0001). Additionally, significantly fewer total allogenic units of RBCs per patient were transfused in the late practice group (mean 1.7 vs. 4.3, p < 0.0001). Intraoperative autotransfusions were used in 97% of the late practice patients but in none of the early practice patients (p < 0.0001). In the late practice group, 119 patients (40%) experienced a major perioperative morbidity or mortality event compared with 106 patients (35%) in the early practice group (p = 0.27).
In this retrospective analysis, we observed significantly lower perioperative Hb, fewer allogenic RBC transfusions, and more autotransfusions in open AAA repairs done in 2003-2006 versus those done in 1980-1982. Additionally, late transfusion practice patients were older and had more comorbid diseases. Despite these observations, no significant differences in perioperative morbidity or mortality were observed between groups.
据报道，在过去二十年中围手术期红细胞（RBC）输血实践发生了显著变化，但腹主动脉瘤（AAA）手术患者的类似数据尚不可得。
将接受初次择期开放性AAA修复手术的成年患者分为两个与输血相关的组之一：早期实践组（1980 - 1982年）或晚期实践组（2003 - 2006年）。将RBC输血和血红蛋白浓度（Hb）作为连续变量进行分析，并使用秩和检验在组间进行比较。使用Fisher精确检验比较组间的围手术期并发症。对数据进行年龄调整，并对分析进行多重比较校正。
与早期实践组相比，晚期实践组患者的术中（平均10 ± 1.4 vs. 11.5 ± 1.5 g/dL）、术后（11.9 ± 1.4 vs. 13.4 ± 1.5 g/dL）和出院时Hb水平（平均10.8 ± 1.2 vs. 12.5 ± 1.5 g/dL）均显著降低（每个变量p < 0.0001）。晚期实践组患者术中接受异体输血的可能性显著降低（46% vs. 99%，p < 0.0001）。此外，晚期实践组每位患者输注的异体RBC总量显著减少（平均1.7 vs. 4.3，p < 0.0001）。97%的晚期实践组患者使用了术中自体输血，而早期实践组患者均未使用（p < 0.0001）。晚期实践组中有119例患者（40%）发生了围手术期重大发病或死亡事件，而早期实践组中有106例患者（35%）发生了此类事件（p = 0.27）。
在这项回顾性分析中，我们观察到与1980 - 1982年进行的开放性AAA修复相比，2003 - 2006年进行的手术围手术期Hb水平显著降低，异体RBC输血减少，自体输血增加。此外，晚期输血实践组的患者年龄更大，合并症更多。尽管有这些观察结果，但两组间围手术期发病率或死亡率未观察到显著差异。
Zotero 插件