Pittman R D, Inahara T
Department of Surgery, St. Vincent Hospital and Medical Center, Portland, Oregon.
Am J Surg. 1990 May;159(5):522-4. doi: 10.1016/s0002-9610(05)81261-9.
In order to eliminate homologous blood transfusions during abdominal aortic aneurysm (AAA) repair, increased usage of autologous predonation and intraoperative salvage is required. To determine what quantity of predonated blood is necessary to completely avoid the use of homologous blood, we reviewed the transfusion histories of 100 consecutive patients undergoing elective AAA repairs. A total of 445 units of blood were transfused, and the number of units required was directly proportional to the size of the aneurysm. One hundred sixty-six units of blood (37%) were homologous, and 279 units (63%) were autologous. Of the autologous units, 255 (91%) were from intraoperative salvage and 24 (9%) were predonated. Stratification of transfusions by size revealed that for aneurysms less than or equal to 7 cm, 132 units of homologous and 21 units of predonated blood were transfused (1.55 units per patient and 0.25 units per patient, respectively). For aneurysms greater than 7 cm, 34 units of homologous and 3 units of predonated blood were used (2.3 units per patient and 0.2 units per patient, respectively). From these data, it is concluded that predonation before surgery of a minimum of 2 units for patients with smaller aneurysms and 3 units for patients with larger aneurysms, combined with intraoperative salvage, should eliminate the need for any homologous blood transfusions associated with elective AAA repair.
为了在腹主动脉瘤（AAA）修复过程中消除同种异体输血，需要增加自体预存献血和术中血液回收的使用量。为了确定完全避免使用同种异体血所需的预存血量，我们回顾了连续100例接受择期AAA修复患者的输血史。总共输注了445单位血液，所需单位数与动脉瘤大小直接相关。166单位血液（37%）为同种异体血，279单位血液（63%）为自体血。在自体血单位中，255单位（91%）来自术中血液回收，24单位（9%）为预存血。按大小对输血进行分层显示，对于直径小于或等于7 cm的动脉瘤，输注了132单位同种异体血和21单位预存血（分别为每位患者1.55单位和0.25单位）。对于直径大于7 cm的动脉瘤，使用了34单位同种异体血和3单位预存血（分别为每位患者2.3单位和0.2单位）。根据这些数据得出结论，对于较小动脉瘤患者术前预存至少2单位血，对于较大动脉瘤患者术前预存至少3单位血，并结合术中血液回收，应可消除择期AAA修复相关的任何同种异体输血需求。
