Jouffroy Romain, Baugnon Thomas, Carli Pierre, Orliaguet Gilles
Department of Anesthesiology and Critical Care, Hôpital Necker-Enfants Malades, AP-HP, University Paris Descartes, Paris Cedex 15, France.
Paediatr Anaesth. 2011 Apr;21(4):385-93. doi: 10.1111/j.1460-9592.2011.03531.x. Epub 2011 Feb 7.
There are so far no existing consensus guidelines regarding red blood cell transfusion during pediatric surgery, and there is a little information regarding red blood cell transfusion policy among pediatric anesthesiologists.
To determine the transfusion threshold and the volumes of packed red blood cell (PRBC) transfusion among French-speaking pediatric anesthesiologists.
A questionnaire of case scenarios was sent to active members of the French Language Society of Pediatrics Anesthesiologists (ADARPEF).
Of the 324 active members of the ADARPEF, 175 (54%) completed the questionnaire. The threshold for blood transfusion varied from 6 to 12 g·dl(-1) depending on the scenario. The hemoglobin threshold for blood transfusion and the volume of blood transfused vary among ADARPEF physicians, for the same class of patients. The median [95% CI] hemoglobin threshold for starting blood transfusion was 7.9 [6.9-8.9], 7.3 [6.4-8.2], and 8.1 [7.0-9.2] g·dl(-1) in the pre-, intra-, and postoperative phase, respectively. The median [95% CI] PRBC volume transfused was 11.7 [6.6-16.8] ml·kg(-1), and the median hemoglobin target was 11.3 [9.8-12.8] g·dl(-1). Physicians ranked age (79%), clinical tolerance of anemia (99%), underlying medical conditions (95%), hemodynamic instability (89%), hemostasis disorder (86%), and sepsis (79%) as the most significant factors affecting their transfusion decisions. Most pediatric anesthesiologists (89%) measure the hemoglobin level before PRBC transfusion.
This survey identifies significant differences in transfusion practice patterns among pediatric anesthesiologists with a median transfusion threshold of 7.6 [6.6-8.6] g·dl(-1) and a median PRBC volume transfusion of 11.7 [16.8-6.6] ml·kg(-1).
目前尚无关于小儿外科手术期间红细胞输血的共识指南，而且小儿麻醉医生中关于红细胞输血策略的信息也很少。
确定说法语的小儿麻醉医生的输血阈值和浓缩红细胞（PRBC）输血量。
向法语小儿麻醉医生协会（ADARPEF）的活跃成员发送了病例情景问卷。
在ADARPEF的324名活跃成员中，175名（54%）完成了问卷。根据情景不同，输血阈值在6至12 g·dl⁻¹之间变化。对于同一类患者，ADARPEF医生之间输血的血红蛋白阈值和输血量各不相同。术前、术中和术后阶段开始输血的血红蛋白阈值中位数[95%CI]分别为7.9[6.9 - 8.9]、7.3[6.4 - 8.2]和8.1[7.0 - 9.2]g·dl⁻¹。PRBC输血量中位数[95%CI]为11.7[6.6 - 16.8]ml·kg⁻¹，血红蛋白目标中位数为11.3[9.8 - 12.8]g·dl⁻¹。医生将年龄（79%）、贫血的临床耐受性（99%）、基础疾病（95%）、血流动力学不稳定（89%）、止血障碍（86%）和脓毒症（79%）列为影响其输血决策的最重要因素。大多数小儿麻醉医生（89%）在输注PRBC前测量血红蛋白水平。
本次调查发现小儿麻醉医生的输血实践模式存在显著差异，输血阈值中位数为7.6[6.6 - 8.6]g·dl⁻¹，PRBC输血量中位数为11.7[16.8 - 6.6]ml·kg⁻¹。
