Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, USA.
Spine (Phila Pa 1976). 2011 Dec 15;36(26):E1736-43. doi: 10.1097/BRS.0b013e3182194a42.
Retrospective review.
Evaluate the transfusion patterns associated with preoperative autologous blood donation (PABD) during posterior lumbar spinal surgery.
There is a paucity of evidence in the literature examining the utility of PABD in elective adult lumbar spinal surgery.
Medical records of 541 patients treated for spinal stenosis between January 1997 and February 2000 were reviewed. Patients were divided into donors (PABD; n = 413) and nondonors (non PABD [NPABD]; n = 128).
Average preoperative hemoglobin (Hb) in the NPABD group was 0.62 units more than in the PABD group (95% confidence interval [CI] = 0.30-0.94). For PABD patients, there was a negative correlation (-0.3) between preoperative Hb and number of units donated. PABD patients who donated 1 and 2 units of blood were, respectively, 7.5 and 9 times more likely to be transfused within the first 24 hours than NPABD patients. NPABD patients were 25 times more likely to need a transfusion of allogeneic blood than PABD patients who donated at least 2 units of blood. Autologous donation was an independent predictor of perioperative blood loss (P < 0.05). Patients who donated at least 2 units of blood lost approximately 1.3 units of Hb more than NPABD patients. The odds of wastage for a PABD patient who had a decompression with noninstrumented fusion were 8.64 times that of a PABD patient who had a decompression with instrumented fusion.
Autologous blood donation induced preoperative anemia and resulted in a lower transfusion threshold than allogeneic blood usage. In addition, we found that autologous donation significantly increased blood loss in the preoperative period as measured by Hb lost. Usage of autologous blood was significantly more efficient in patients who underwent instrumented fusion than in patients with less complex surgery.
回顾性研究。
评估后路腰椎手术中与术前自体输血（PABD）相关的输血模式。
在成人腰椎择期手术中，PABD 的应用价值，文献报道甚少。
对 1997 年 1 月至 2000 年 2 月期间接受脊柱狭窄治疗的 541 例患者的病历进行回顾性分析。患者分为献血者（PABD；n = 413）和非献血者（非 PABD [NPABD]；n = 128）。
NPABD 组患者术前血红蛋白（Hb）平均比 PABD 组高 0.62 单位（95%置信区间 [CI] = 0.30-0.94）。对于 PABD 患者，术前 Hb 与献血量呈负相关（-0.3）。献血 1 单位和 2 单位的 PABD 患者，与 NPABD 患者相比，分别在 24 小时内输血的可能性高 7.5 倍和 9 倍。NPABD 患者需要异体输血的可能性比至少献血 2 单位的 PABD 患者高 25 倍。自体献血是围手术期失血的独立预测因素（P < 0.05）。至少献血 2 单位的患者比 NPABD 患者多丢失约 1.3 单位的 Hb。行减压融合术但未使用器械固定的 PABD 患者发生浪费的可能性是行减压融合术且使用器械固定的 PABD 患者的 8.64 倍。
自体输血导致术前贫血，并导致比异体输血更低的输血阈值。此外，我们发现，自体输血在术前期间通过 Hb 丢失导致失血增加。与手术较为复杂的患者相比，自体血的应用在接受器械融合的患者中更为有效。
