早期积极输注新鲜冰冻血浆以减少细胞减灭术中大量输血的效果。
Effectiveness of early and aggressive administration of fresh frozen plasma to reduce massive blood transfusion during cytoreductive surgery.
机构信息
University of New South Wales, Department of Surgery, St George Hospital, Sydney, Australia.
出版信息
J Gastrointest Oncol. 2013 Mar;4(1):30-9. doi: 10.3978/j.issn.2078-6891.2012.046.
BACKGROUND
Cytoreductive surgery (CRS) combined with perioperative intraperitoneal chemotherapy (PIC) has been consistently associated with high volume blood loss and red blood cell (RBC) transfusion. This study evaluates the effectiveness of the introduction of a novel protocol to reduce blood loss and subsequent intra-operative transfusion in patients with high volume disease.
METHODS
One hundred and thirty-one consecutive patients with high volume disease (peritoneal cancer index ≥16) who underwent CRS and PIC were evaluated. Group I consisted of the sixty patients (46%) treated before June 2006. Group II consistent of the seventy-one (54%) patients treated after June 2006 under the new protocol. The clinical and treatment-related data of patients in the two groups were compared.
RESULTS
Group II was associated with reduced intra-operative red blood cell transfusion (P<0.001), reduced cryoprecipitate transfusion (P=0.020), reduced platelet transfusion (P<0.001), reduced fresh frozen plasma transfusion (P=0.024), reduced operation length (P<0.001), reduced crystalloid administration (P<0.001) and reduced colloid administration (P<0.001). Group II was also associated with increased transfusion of FFP in the first half of the surgical intervention relative to the second half [FFP1(st)(:)FFP2(nd) ratio >1 (P<0.001)] and increased transfusion of RBC in the first half of the surgical intervention relative to the second half [RBC1(st)(:)RBC2(nd) ratio ≥1 (P=0.016)].
CONCLUSION
Early administration of fresh frozen plasma combined with restrictive fluid resuscitation may reduce overall intra-operative transfusion of RBC and other blood components.
背景
细胞减灭术（CRS）联合围手术期腹腔内化疗（PIC）一直与大量失血和红细胞（RBC）输血有关。本研究评估了引入一种新方案以减少高容量疾病患者的失血和随后的术中输血的有效性。
方法
评估了 131 例连续接受 CRS 和 PIC 的高容量疾病患者（腹膜癌指数≥16）。第 I 组包括 60 例（46%）于 2006 年 6 月前治疗的患者。第 II 组由 71 例（54%）于 2006 年 6 月后根据新方案治疗的患者组成。比较两组患者的临床和治疗相关数据。
结果
第 II 组术中红细胞输血减少（P<0.001），冷沉淀输血减少（P=0.020），血小板输血减少（P<0.001），新鲜冷冻血浆输血减少（P=0.024），手术时间缩短（P<0.001），晶体液用量减少（P<0.001），胶体液用量减少（P<0.001）。与手术干预的后半段相比，第 II 组在手术干预的前半段中更倾向于输注更多的 FFP [FFP1（st）：FFP2（nd）比值>1（P<0.001）]，并且在手术干预的前半段中更倾向于输注更多的 RBC [RBC1（st）：RBC2（nd）比值≥1（P=0.016）]。
结论
早期给予新鲜冷冻血浆并结合限制性液体复苏可能会减少 RBC 和其他血液成分的总体术中输血。
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