Hajjar Ludhmila Abrahão, Fukushima Julia Tizue, Almeida Juliano Pinheiro de, Osawa Eduardo Atsushi, Galas Filomena Regina Barbosa Gomes
Surgical Intensive Care Unit, Heart Institute, University of São Paulo, Av Dr Enéas de Carvalho Aguiar, São Paulo, Brazil.
Curr Opin Anaesthesiol. 2015 Feb;28(1):81-8. doi: 10.1097/ACO.0000000000000144.
Anemia has been demonstrated to be detrimental in several populations such as high-surgical-risk patients, critically ill elderly, and cardiac patients. Red blood cell transfusion is the most commonly prescribed therapy for anemia. Despite being life-saving, it carries a risk that ranges from mild complications to death. The aim of this review is to discuss the risks of anemia and blood transfusion, and to describe recent developments in the strategies to reduce allogeneic blood transfusion.
In the past decades, clinical studies comparing transfusion strategies in different populations were conducted. Despite the challenges imposed by the development of such studies, evidence-based medicine on transfusion medicine in critically ill patients is being created. Different results arising from these studies reflect population heterogeneity, specific circumstances, and difficulties in measuring the impact of anemia and transfusion in a clinical trial.
An adequate judgment of a clinical condition associated with proper application of the available literature is the cornerstone in the management of transfusion in critical care. Apart from this individualized strategy, the institution of a patient blood management program allows goal-directed approach through preoperative recognition of anemia, surgical efforts to minimize blood loss, and continuous assessment of the coagulation status.
贫血已被证明对多个群体有害，如高手术风险患者、重症老年患者和心脏病患者。红细胞输血是治疗贫血最常用的方法。尽管它能挽救生命，但也存在从轻微并发症到死亡的风险。本综述的目的是讨论贫血和输血的风险，并描述减少异体输血策略的最新进展。
在过去几十年里，开展了比较不同人群输血策略的临床研究。尽管开展此类研究面临诸多挑战，但针对重症患者输血医学的循证医学正在形成。这些研究产生的不同结果反映了人群异质性、具体情况以及在临床试验中衡量贫血和输血影响的困难。
对临床状况进行充分判断并合理应用现有文献是重症监护中输血管理的基石。除了这种个体化策略外，建立患者血液管理计划可通过术前识别贫血、采取手术措施尽量减少失血以及持续评估凝血状态来实现目标导向的方法。
