Machado Rui, Loureiro Luís, Antunes Inês, Coutinho Jorge, Almeida Rui
Angiology and Vascular Surgery Department. Hospital Geral de Santo António. Oporto Hospital Center. Porto.
Hematology Department. Hospital Geral de Santo António. Oporto Hospital Center. Porto.
Acta Med Port. 2016 May;29(5):310-4. doi: 10.20344/amp.7283. Epub 2016 May 31.
Comparatively to open repair, endovascular aneurysm repair has reduced transfusion rates but thereâs no recommendation about number of red blood cells units to be crossmatched preoperatively. Our aim is contribute to the analysis of red blood cells units needs in endovascular and hybrid aortic aneurysm repair and developing a protocol for maximum surgical blood orders schedule.
We retrospectively analyzed our prospective database of elective endovascular aneurysm repair from 2001 to 2012. We analyzed patients' age, gender, ASA classification, maximum surgical blood orders schedule, red blood cells units transfused and timings, types of endoprosthesis, red blood cells units consumption/endoprosthesis' type ratio, crossmatch to transfusion ratio, conversion to open repair, hemoglobin concentrations before surgery and discharge.
We selected 187 patients, 90% men, mean age 73.1, ASA mode III. The endoprosthesis were aorto-bi-iliac in 71%, aorto-uni-iliac in 23% and thoracic in 6%. Of these, 72,6% of the patients did not require blood transfusion. We transfused 171 red blood cells units. Crossmatch to transfusion ratio was 10.1 until 2010 and 7.3 after. The ratio of red blood cells units consumption/endoprosthesis in the first 24 hours was 0.21 red blood cells units/aorto-bi-iliac, 0.46 red blood cells units/aorto-uni-iliac, 0.8 red blood cells units/thoracic, 1.3 red blood cells units/hybrid-thoracic and 2 red blood cells units/hybrid-aorto-bi-iliac. A statistical correlation was observed between red blood cells units transfused postoperatively and type of endoprosthesis (p < 0.001) and between ASA classification and red blood cells units transfused after 24 hours (p < 0.01).
Guidelines from the British Society of Haematology are based on a crossmatch to transfusion ratio of 2:1. Our crossmatch to transfusion ratio was 10.1 until 2010 and 7.3 from 2011 to 2012.
These results changed our policy of maximum surgical blood orders schedule for endovascular aneurysm repair. We now type and screen aorto-bi-iliac and aorto-uni-iliac. We crossmatch two red blood cells units for thoracic, three red blood cells units for hybrid thoracic and four red blood cells units for hybrid abdominal procedures. This may lead to financial savings, improved efficiency and reduce workload in hematology department.
与开放性修复相比，血管内动脉瘤修复术降低了输血率，但对于术前交叉配血的红细胞单位数量尚无推荐意见。我们的目的是助力分析血管内和杂交主动脉瘤修复术中红细胞单位的需求，并制定最大手术用血预订计划的方案。
我们回顾性分析了2001年至2012年择期血管内动脉瘤修复术的前瞻性数据库。我们分析了患者的年龄、性别、美国麻醉医师协会（ASA）分级、最大手术用血预订计划、输注的红细胞单位数量及时间、血管内假体类型、红细胞单位消耗量/血管内假体类型比率、交叉配血与输血比率、转为开放性修复的情况、术前及出院时的血红蛋白浓度。
我们选取了187例患者，其中90%为男性，平均年龄73.1岁，ASA分级为III级。血管内假体类型为双髂动脉型占71%，单髂动脉型占23%，胸段型占6%。其中，72.6%的患者无需输血。我们共输注了171个红细胞单位。2010年之前交叉配血与输血比率为10.1，之后为7.3。术后24小时内红细胞单位消耗量/血管内假体的比率为：双髂动脉型0.21个红细胞单位/个，单髂动脉型0.46个红细胞单位/个，胸段型0.8个红细胞单位/个，杂交胸段型1.3个红细胞单位/个，杂交双髂动脉型2个红细胞单位/个。观察到术后输注的红细胞单位数量与血管内假体类型之间存在统计学相关性（p < 0.001），以及ASA分级与术后24小时后输注的红细胞单位数量之间存在统计学相关性（p < 0.01）。
英国血液学学会的指南基于交叉配血与输血比率为2:1。我们的交叉配血与输血比率在2010年之前为10.1，2011年至2012年为7.3。
这些结果改变了我们血管内动脉瘤修复术的最大手术用血预订计划政策。我们现在对双髂动脉型和单髂动脉型进行血型鉴定和筛查。对于胸段手术交叉配血2个红细胞单位，杂交胸段手术交叉配血3个红细胞单位，杂交腹段手术交叉配血4个红细胞单位。这可能会节省费用、提高效率并减轻血液科的工作量。
