Silva Pedro Gabriel Melo de Barros E, Ikeoka Dimas Tadahiro, Fernandes Viviane Aparecida, Lasta Nilza Sandra, Silva Debora Prudencio E, Okada Mariana Yumi, Izidoro Beatriz Akinaga, Garcia José Carlos Teixeira, Baruzzi Antonio Claudio do Amaral, Furlan Valter
Einstein (Sao Paulo). 2013 Jul-Sep;11(3):310-6. doi: 10.1590/s1679-45082013000300009.
Cardiac surgeries are sometimes followed by significant blood loss, and blood transfusions may be necessary. However, indiscriminant use of blood components can result in detrimental effects for the patient. We evaluated the short-term effects of implementation of a protocol for the rational use of blood products in the perioperative period of cardiac surgery.
Between April and June 2011, an institutional protocol was implemented in a private hospital specializing in cardiology to encourage rational use of blood products, with the consent and collaboration of seven cardiac surgery teams. We collected clinical and demographic data on the patients. The use of blood products and clinical outcomes were analyzed during hospital stay before and after protocol implementation. The protocol consisted of an institutional campaign with an educational intervention to surgical and anesthesiology teams; the goal was to tailor blood transfusion practice according to clinical goals (anemia with hemodynamic changes and significant ventricular dysfunction) and to make routine the prescription of ε-aminocaproic acid intraoperatively, which is recommended by international guidelines based on scientific evidence.
After three months of protocol implementation, the use of ε-aminocaproic acid increased from 31% to 100%. A total of 67% of surgeries before protocol implementation required any blood transfusion, compared with 40% that required any blood transfusion after protocol implementation in subsequent months of the same year (p<0.001). There was no significant difference in clinical outcomes assessed before and after implementation of the protocol.
The rational use of blood products associated with infusion of ε-aminocaproic acid has the potential to reduce the number of blood transfusions in perioperative of cardiac surgeries, but it can affect the risk of complications.
心脏手术有时会导致大量失血，可能需要输血。然而，不加区分地使用血液成分可能会对患者产生不利影响。我们评估了在心脏手术围手术期实施合理使用血液制品方案的短期效果。
2011年4月至6月期间，在一家专门从事心脏病学的私立医院实施了一项机构方案，在七个心脏手术团队的同意和协作下，鼓励合理使用血液制品。我们收集了患者的临床和人口统计学数据。分析了方案实施前后住院期间血液制品的使用情况和临床结果。该方案包括针对外科和麻醉团队的教育干预机构宣传活动；目标是根据临床目标（伴有血流动力学变化和明显心室功能障碍的贫血）调整输血实践，并使术中使用ε-氨基己酸成为常规操作，这是基于科学证据的国际指南所推荐的。
方案实施三个月后，ε-氨基己酸的使用从31%增加到100%。方案实施前，共有67%的手术需要输血，而在同年随后几个月方案实施后，这一比例为40%（p<0.001）。方案实施前后评估的临床结果没有显著差异。
合理使用与输注ε-氨基己酸相关的血液制品有可能减少心脏手术围手术期的输血量，但可能会影响并发症风险。
