Spence R K, Carson J A, Poses R, McCoy S, Pello M, Alexander J, Popovich J, Norcross E, Camishion R C
Department of Surgery, Cooper Hospital/University Medical Center, Robert Wood Johnson School of Medicine, University of Medicine and Dentistry of New Jersey, Camden.
Am J Surg. 1990 Mar;159(3):320-4. doi: 10.1016/s0002-9610(05)81227-9.
To clarify the widespread practice of preoperative transfusion to attain a 10 g/dL level of hemoglobin, the relationship between preoperative hemoglobin level, operative blood loss, and mortality was studied by analyzing the results of 113 operations in 107 consecutive Jehovah's Witness patients who underwent major elective surgery. Ninety-three patients had preoperative hemoglobin values greater than 10 g/dL; 20 had preoperative hemoglobin levels between 6 to 10 g/dL. Mortality for preoperative hemoglobin levels greater than 10 g/dL was 3 of 93 (3.2%); for preoperative hemoglobin levels between 6 to 10 g/dL, mortality was 1 of 20 (5%). Mortality was significantly increased with an estimated blood loss of greater than 500 mL, regardless of the preoperative hemoglobin level (p less than 0.025). More importantly, there was no mortality if estimated blood loss was less than 500 mL, regardless of the preoperative hemoglobin level. From these data, we conclude that: (1) Mortality in elective surgery appears to depend more on estimated blood loss than on preoperative hemoglobin levels; and (2) Elective surgery can be done safely in patients with a preoperative hemoglobin level as low as 6 g/dL if estimated blood loss is kept below 500 mL.
为了阐明术前输血以达到血红蛋白水平10g/dL这一普遍做法，通过分析107例连续接受大择期手术的耶和华见证会患者的113例手术结果，研究了术前血红蛋白水平、术中失血量和死亡率之间的关系。93例患者术前血红蛋白值大于10g/dL；20例患者术前血红蛋白水平在6至10g/dL之间。术前血红蛋白水平大于10g/dL的患者死亡率为93例中的3例（3.2%）；术前血红蛋白水平在6至10g/dL之间的患者死亡率为20例中的1例（5%）。无论术前血红蛋白水平如何，估计失血量大于500mL时死亡率显著增加（p小于0.025）。更重要的是，无论术前血红蛋白水平如何，如果估计失血量小于500mL则无死亡病例。根据这些数据，我们得出结论：（1）择期手术的死亡率似乎更多地取决于估计失血量而非术前血红蛋白水平；（2）如果估计失血量控制在500mL以下，术前血红蛋白水平低至6g/dL的患者也可安全地进行择期手术。
