Department of Anaesthesia and Intensive Care, Evangelical Hospital Vienna, Austria.
Eur J Anaesthesiol. 2013 Jun;30(6):270-382. doi: 10.1097/EJA.0b013e32835f4d5b.
The aims of severe perioperative bleeding management are three-fold. First, preoperative identification by anamesis and laboratory testing of those patients for whom the perioperative bleeding risk may be increased. Second, implementation of strategies for correcting preoperative anaemia and stabilisation of the macro- and microcirculations in order to optimise the patient's tolerance to bleeding. Third, targeted procoagulant interventions to reduce the amount of bleeding, morbidity, mortality and costs. The purpose of these guidelines is to provide an overview of current knowledge on the subject with an assessment of the quality of the evidence in order to allow anaesthetists throughout Europe to integrate this knowledge into daily patient care wherever possible. The Guidelines Committee of the European Society of Anaesthesiology (ESA) formed a task force with members of scientific subcommittees and individual expert members of the ESA. Electronic databases were searched without language restrictions from the year 2000 until 2012. These searches produced 20 664 abstracts. Relevant systematic reviews with meta-analyses, randomised controlled trials, cohort studies, case-control studies and cross-sectional surveys were selected. At the suggestion of the ESA Guideline Committee, the Scottish Intercollegiate Guidelines Network (SIGN) grading system was initially used to assess the level of evidence and to grade recommendations. During the process of guideline development, the official position of the ESA changed to favour the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. This report includes general recommendations as well as specific recommendations in various fields of surgical interventions. The final draft guideline was posted on the ESA website for four weeks and the link was sent to all ESA members. Comments were collated and the guidelines amended as appropriate. When the final draft was complete, the Guidelines Committee and ESA Board ratified the guidelines.
严重围手术期出血管理的目标有三个。首先，通过病史和实验室检查来识别那些围手术期出血风险可能增加的患者。其次，实施策略以纠正术前贫血并稳定大循环和微循环，以优化患者对出血的耐受能力。第三，针对性的促凝干预以减少出血、发病率、死亡率和成本。本指南的目的是提供关于这一主题的当前知识概述，并评估证据的质量，以便让整个欧洲的麻醉师尽可能地将这些知识融入日常患者护理中。欧洲麻醉学会（ESA）指南委员会成立了一个工作组，成员包括科学分委员会的成员和 ESA 的个别专家成员。在没有语言限制的情况下，从 2000 年到 2012 年，电子数据库进行了搜索。这些搜索产生了 20664 个摘要。选择了相关的系统综述，包括荟萃分析、随机对照试验、队列研究、病例对照研究和横断面调查。根据 ESA 指南委员会的建议，最初使用苏格兰校际指南网络（SIGN）分级系统来评估证据水平并对建议进行分级。在指南制定过程中，ESA 的官方立场发生了变化，转而支持推荐评估、制定和评价（GRADE）系统。本报告包括一般建议以及在各种外科干预领域的具体建议。最终草案指南在 ESA 网站上发布了四周，并向所有 ESA 成员发送了链接。收集了意见，并对指南进行了适当修改。当最终草案完成后，指南委员会和 ESA 理事会批准了该指南。
