Department of Anesthesiology, College of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
Spine J. 2012 Jun;12(6):455-62. doi: 10.1016/j.spinee.2012.03.032. Epub 2012 May 5.
Previous studies have demonstrated significant changes in red blood cell (RBC) transfusion practice over several decades.
The purpose of the present study was to ascertain changes in transfusion practice during a 25-year study epoch and determine whether these changes had any impact on the frequency of perioperative morbidity and mortality in pediatric patients undergoing major spine surgery.
Retrospective chart review.
Pediatric patients undergoing elective scoliosis surgery.
Impact of RBC transfusion on perioperative morbidity and mortality.
Pediatric patients undergoing elective scoliosis surgery were stratified into one of two transfusion-related groups: 1975 to 1985 (ie, pre-human immunodeficiency virus screening, early practice group, n=177) or 1990 to 2000 (ie, recent practice group, n=192). Transfusion and perioperative outcome data were obtained from medical records. Red blood cell use was analyzed as a continuous variable and compared between groups using the Wilcoxon rank sum test, as were preoperative, postoperative, and discharge hemoglobin concentration. Age-adjusted data were compared between groups using chi-square or Fisher exact tests.
Patients in the recent practice group had significantly worse comorbid disease and more complex procedures compared with those in the early practice group. The percentage of patients in the recent practice group receiving allogeneic RBC transfusions was significantly less than the early group (37.5% vs. 89.8%, p<.001). Utilization of autologous RBC and intraoperative autotransfusion was significantly greater in the recent practice group (5.1% vs. 47.4% and 20.9% vs. 95.8%, respectively). Hemoglobin concentrations were significantly lower for all time periods in the recent practice group. There were no differences in major morbidity or mortality between groups.
In this retrospective review, we report a significant change in blood management strategies in pediatric patients undergoing elective scoliosis surgery. We demonstrated a shift from utilization of allogeneic RBC transfusion toward preoperative donation and intraoperative autotransfusion. Although transfusion triggers were significantly lower in the recent practice group, we were unable to demonstrate a difference in major morbidity or mortality. Utilization of autologous RBC transfusion was safe and effective in reducing allogeneic RBC transfusions in this study. The advantages of autologous blood transfusion may be in preserving a relatively scarce resource (ie, allogeneic blood), rather than mitigating transfusion-related complications.
先前的研究表明，在几十年的时间里，红细胞（RBC）输血实践发生了重大变化。
本研究旨在确定在 25 年的研究期间输血实践的变化，并确定这些变化是否对接受大脊柱手术的儿科患者围手术期发病率和死亡率的频率有任何影响。
回顾性图表审查。
接受择期脊柱侧凸手术的儿科患者。
红细胞输注对围手术期发病率和死亡率的影响。
将接受择期脊柱侧凸手术的儿科患者分为两组：1975 年至 1985 年（即人类免疫缺陷病毒筛查前、早期实践组，n=177）或 1990 年至 2000 年（即近期实践组，n=192）。从病历中获取输血和围手术期结果数据。使用 Wilcoxon 秩和检验比较两组之间的红细胞使用情况作为连续变量，比较两组之间的术前、术后和出院时血红蛋白浓度。使用卡方或 Fisher 精确检验比较年龄调整后的数据。
与早期实践组相比，近期实践组患者的合并症和手术更为复杂。近期实践组接受同种异体 RBC 输血的患者比例明显低于早期组（37.5%比 89.8%，p<.001）。近期实践组患者自体 RBC 和术中自体输血的使用率明显更高（分别为 5.1%比 47.4%和 20.9%比 95.8%）。近期实践组所有时间段的血红蛋白浓度均明显较低。两组之间主要发病率或死亡率无差异。
在这项回顾性研究中，我们报告了在接受择期脊柱侧凸手术的儿科患者中血液管理策略发生了重大变化。我们发现，从使用同种异体 RBC 输血转变为术前献血和术中自体输血。尽管近期实践组的输血触发明显较低，但我们未能证明主要发病率或死亡率存在差异。在这项研究中，自体 RBC 输血的使用是安全有效的，可以减少异体 RBC 输血。自体输血的优点可能在于保存相对稀缺的资源（即异体血液），而不是减轻输血相关并发症。
