输血、胶体治疗以及手术期间白蛋白量的可能节省：日本麻醉医师协会认证医院调查的数据分析
Blood transfusion, colloid therapy and the possible saving of albumin volumes during surgery: data analysis of the survey for certified hospitals of the Japanese Society of Anesthesiologists.
作者信息
Miyao Hideki
机构信息
Department of Anesthesiology, Saitama Medical Center, Saitama Medical University, 1981, Kamoda, Kawagoe, Saitama, 350-8550, Japan.
出版信息
J Anesth. 2016 Jun;30(3):384-90. doi: 10.1007/s00540-015-2136-3. Epub 2016 Jan 14.
PURPOSE
Third-generation hydroxyethyl starch (HES) 130/0.4 has a larger dose limitation (up to 50 mL/kg/day) than HES 70/0.5 (up to 1000 mL/day) which has been used in Japan for 40 years. The aim of this study was to survey the current intraoperative blood transfusion and volume therapy and to predict the possible reduction of intraoperative albumin consumption assuming further replacement by HES 130/0.4 using data obtained from a survey by the Japanese Society of Anesthesiologists (JSA), although HES130/0.4 was not launched in Japan during this survey period.
METHODS
In a JSA survey conducted at JSA-certified hospitals, 12,856 patients with a certain amount of blood loss were analyzed for 1 month (April, 2012). The patients were divided into two groups-group A included patients aged ≥11 years and group B included patients aged <10 years. The possible lower volume of intraoperative albumin was calculated assuming that HES 130/0.4 was used up to a dose of 50 mL/kg.
RESULTS
Blood loss (total 15,111 L; 15,057 L in group A and 54 L in group B) was treated with allogeneic transfusion (total 7970 L; 7893 L in group A and 77 L in group B) and auto-transfusion (total 1777 L; 1771 L in group A and 6 L in group B) in both groups (n = 11,670 and 119). Albumin (total 1391 L; 1376 L in group A and 15 L in group B), and HES 70/0.5 (total 7645 L; 7638 L in group A and 7 L in group B) were used in both groups (n = 10,850 and 116). Five percent and 4.4 % albumin (total 1189 L; 1180 L in group A and 9 L in group B) could be replaced by HES 130/0.4 if HES 130/0.4 had been used up to a dose of 50 mL/kg.
CONCLUSION
Blood loss (15,111 L) was replaced with allogeneic transfusion (53 %), auto-transfusion (12 %), albumin (9 %) and HES 70/0.5 (51 %) during surgery in April 2012. The predicted volume of 5 and 4.4 % albumin saved during this 1-month period if HES 130/0.4 had been used up to a dose of 50 mL/kg was 1189 L (86 % of actual amount used).
目的
第三代羟乙基淀粉（HES）130/0.4的剂量限制（高达50毫升/千克/天）比在日本已使用40年的HES 70/0.5（高达1000毫升/天）更大。本研究的目的是调查当前的术中输血和容量治疗情况，并利用日本麻醉医师协会（JSA）调查获得的数据，预测假设进一步用HES 130/0.4替代时术中白蛋白消耗量可能的减少，尽管在本调查期间HES130/0.4尚未在日本上市。
方法
在JSA认证医院进行的一项JSA调查中，对12856例有一定失血量的患者进行了为期1个月（2012年4月）的分析。患者分为两组——A组包括年龄≥11岁的患者，B组包括年龄<10岁的患者。假设使用HES 130/0.4的剂量高达50毫升/千克，计算术中白蛋白可能的较低使用量。
结果
两组（n = 11670和119）的失血量（总计15111升；A组15057升，B组54升）均采用异体输血（总计7970升；A组7893升，B组77升）和自体输血（总计1777升；A组1771升，B组6升）进行治疗。两组（n = 10850和116）均使用了白蛋白（总计1391升；A组1376升，B组15升）和HES 70/0.5（总计7645升；A组7638升，B组7升）。如果使用HES 130/0.4的剂量高达50毫升/千克，5%和4.4%的白蛋白（总计1189升；A组1180升，B组9升）可被HES 130/0.4替代。
结论
2012年4月手术期间，失血量（15111升）通过异体输血（53%）、自体输血（12%）、白蛋白（9%）和HES 70/0.5（51%）进行了补充。如果使用HES 130/0.4的剂量高达50毫升/千克，则在这1个月期间预测可节省的5%和4.4%白蛋白量为1189升（占实际使用量的86%）。
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