Ann Thorac Surg. 2011 Mar;91(3):944-82. doi: 10.1016/j.athoracsur.2010.11.078.
Practice guidelines reflect published literature. Because of the ever changing literature base, it is necessary to update and revise guideline recommendations from time to time. The Society of Thoracic Surgeons recommends review and possible update of previously published guidelines at least every three years. This summary is an update of the blood conservation guideline published in 2007.
The search methods used in the current version differ compared to the previously published guideline. Literature searches were conducted using standardized MeSH terms from the National Library of Medicine PUBMED database list of search terms. The following terms comprised the standard baseline search terms for all topics and were connected with the logical 'OR' connector--Extracorporeal circulation (MeSH number E04.292), cardiovascular surgical procedures (MeSH number E04.100), and vascular diseases (MeSH number C14.907). Use of these broad search terms allowed specific topics to be added to the search with the logical 'AND' connector.
In this 2011 guideline update, areas of major revision include: 1) management of dual anti-platelet therapy before operation, 2) use of drugs that augment red blood cell volume or limit blood loss, 3) use of blood derivatives including fresh frozen plasma, Factor XIII, leukoreduced red blood cells, platelet plasmapheresis, recombinant Factor VII, antithrombin III, and Factor IX concentrates, 4) changes in management of blood salvage, 5) use of minimally invasive procedures to limit perioperative bleeding and blood transfusion, 6) recommendations for blood conservation related to extracorporeal membrane oxygenation and cardiopulmonary perfusion, 7) use of topical hemostatic agents, and 8) new insights into the value of team interventions in blood management.
Much has changed since the previously published 2007 STS blood management guidelines and this document contains new and revised recommendations.
实践指南反映了已发表的文献。由于文献基础不断变化，因此有必要不时更新和修改指南建议。胸外科医师学会建议至少每三年审查并可能更新以前发布的指南。本摘要更新了 2007 年发布的血液保护指南。
当前版本中使用的搜索方法与以前发布的指南有所不同。使用国家医学图书馆 PUBMED 数据库搜索词列表中的标准化 MeSH 术语进行文献检索。以下术语构成了所有主题的标准基线搜索词，并与逻辑“或”连接器连接——体外循环（MeSH 编号 E04.292）、心血管外科手术（MeSH 编号 E04.100）和血管疾病（MeSH 编号 C14.907）。使用这些广泛的搜索词允许使用逻辑“与”连接器向搜索中添加特定主题。
在本次 2011 年指南更新中，主要修订领域包括：1）手术前双重抗血小板治疗的管理，2）使用增加红细胞体积或限制失血的药物，3）使用血液衍生物，包括新鲜冷冻血浆、因子 XIII、白细胞减少的红细胞、血小板血浆分离术、重组因子 VII、抗凝血酶 III 和因子 IX 浓缩物，4）血液回收管理的变化，5）使用微创程序限制围手术期出血和输血，6）与体外膜氧合和心肺灌注相关的血液保护建议，7）使用局部止血剂，以及 8）团队干预在血液管理中的价值的新见解。
自上次发布的 2007 年 STS 血液管理指南以来，情况发生了很大变化，本文件包含了新的和修订的建议。
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