Mangu Hanumantha Rao, Samantaray Aloka, Anakapalli Muralidhar
Department of Anaesthesiology, Critical Care and Pain Medicine, Sri Venkateswara Institute of Medical Sciences University, Tirupati, Andhra Pradesh, India.
Indian J Anaesth. 2014 Sep;58(5):616-21. doi: 10.4103/0019-5049.144669.
The primary reasons for blood transfusion in cardiac surgery are to correct anaemia and to improve tissue oxygen delivery. However, there is a considerable debate regarding the actual transfusion trigger at which the benefits of transfusion overweight the risk. The association between extreme haemodilution, transfusion and adverse outcome after cardio pulmonary bypass (CPB) is not clear and the current available literature is not sufficient to provide a strong recommendation regarding the safe haematocrit range during CPB. There is no quality evidence to support use of fresh red blood cell except during massive transfusion or exchange transfusion in neonate. Overall concern regarding the safety of allogeneic blood transfusion resulted in the search for autologous blood transfusion and perioperative blood salvage. The aim of this review is to provide cardiac surgery specific clinically useful guidelines pertaining to transfusion triggers, optimal haemodilution during CPB, autologous blood transfusion and role of perioperative blood salvage based on available evidence.
心脏手术中输血的主要原因是纠正贫血和改善组织氧输送。然而，对于实际的输血触发点，即输血的益处超过风险的点，存在相当大的争议。体外循环（CPB）后极重度血液稀释、输血与不良结局之间的关联尚不清楚，目前可得的文献不足以就CPB期间的安全血细胞比容范围提供有力推荐。除了新生儿大量输血或换血输血期间，没有高质量证据支持使用新鲜红细胞。对异体输血安全性的总体担忧促使人们寻求自体输血和围手术期血液回收。本综述的目的是基于现有证据，提供针对心脏手术的、关于输血触发点、CPB期间的最佳血液稀释、自体输血以及围手术期血液回收作用的临床实用指南。
