Colomina M J, Basora Macaya M, Bisbe Vives E
Servicio de Anestesiología y Reanimación, Hospital Universitario Vall d'Hebron, Barcelona, España.
Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, España.
Rev Esp Anestesiol Reanim. 2015 Jun;62 Suppl 1:3-18. doi: 10.1016/S0034-9356(15)30002-5.
The objective of this article is to determine the availability of a perioperative transfusion management program (Patient Blood Management [PBM]) in various hospitals through a survey that included a description of the preanesthesia visit, the availability and use of the various blood-sparing techniques and the factors limiting their implementation in elective surgery. The survey included 42 questions, directed at the representative departments of anesthesiology of hospitals in Spain (n=91). The survey was conducted from September to November 2012. We analyzed the 82 surveys in which all the questions were answered (90%). Preoperative consultations are routinely performed (>70%) in 87% of the hospitals. The time from the consultation to surgery varied between 1 week and 2 months for 74% of the patients scheduled for orthopedic or trauma surgery, 78% of those scheduled for oncologic surgery and 77% of those scheduled for cardiac surgery. Almost all hospitals (77, 94%) had a transfusion committee, and 90% of them had an anesthesiologist on the committee. Seventy-nine percent of the hospitals had a blood-sparing program, and the most widely used technique was the use of antifibrinolytic agents (75% of hospitals), followed by intraoperative and postoperative blood recovery in equal proportions (67%). Optimization of preoperative hemoglobin was routinely performed with intravenous iron in 39% of the hospitals and with recombinant erythropoietin in 28% of the hospitals. The absence of a well-established circuit and the lack of involvement and collaboration with the surgical team were the main limiting factors in implementing PBM. Currently, the implementation of PBM in Spain could be considered acceptable, but it could also be improved, especially in the treatment of preoperative anemia. The implementation of PBM requires multidisciplinary collaboration among all personnel responsible for perioperative care, including the health authorities.
本文的目的是通过一项调查来确定围手术期输血管理项目（患者血液管理[PBM]）在各医院的可用性，该调查包括对麻醉前访视的描述、各种血液保护技术的可用性和使用情况以及限制其在择期手术中实施的因素。该调查包括42个问题，针对西班牙医院（n = 91）的麻醉学代表性科室。调查于2012年9月至11月进行。我们分析了82份所有问题均得到回答的调查问卷（90%）。87%的医院常规进行术前会诊（>70%）。对于74%计划进行骨科或创伤手术的患者、78%计划进行肿瘤手术的患者以及77%计划进行心脏手术的患者，从会诊到手术的时间在1周和2个月之间。几乎所有医院（77, 94%）都有一个输血委员会，其中90%的委员会中有麻醉医生。79%的医院有血液保护项目，最广泛使用的技术是使用抗纤溶药物（75%的医院），其次是术中及术后血液回收，比例相同（67%）。39%的医院常规使用静脉铁剂优化术前血红蛋白，28%的医院使用重组促红细胞生成素。缺乏完善的流程以及与手术团队缺乏参与和协作是实施PBM的主要限制因素。目前，西班牙PBM实施情况可认为尚可，但仍有改进空间，尤其是在术前贫血治疗方面。实施PBM需要包括卫生当局在内的所有负责围手术期护理的人员进行多学科协作。
