Sikorski R A, Rizkalla N A, Yang W W, Frank S M
Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, MA, USA.
Department of Anesthesiology/Critical Care Medicine, Johns Hopkins Health System Blood Management Program, The Johns Hopkins Medical Institutions, MA, USA.
Vox Sang. 2017 Aug;112(6):499-510. doi: 10.1111/vox.12527. Epub 2017 Jun 5.
Almost 150 years after the first autologous blood transfusion was reported, intraoperative blood salvage has become an important method of blood conservation. The primary goal of autologous transfusion is to reduce or avoid allogeneic red blood cell transfusion and the associated risks and costs. Autologous salvaged blood does not result in immunological challenge and its consequences, provides a higher quality red blood cell that has not been subjected to the adverse effects of blood storage, and can be more cost-effective than allogeneic blood when used for carefully selected surgical patients. Cardiac, orthopaedic and vascular surgery procedures with large anticipated blood loss can clearly benefit from the use of cell salvage. There are safety concerns in cases with gross bacterial contamination. There are theoretical safety concerns in obstetrical and cancer surgery; however, careful cell washing as well as leucoreduction filters makes for a safer autologous transfusion in these circumstances. Further studies are needed to determine whether oncologic outcomes are impacted by transfusing salvaged blood during cancer surgery. In this new era of patient blood management, where multimodal methods of reducing dependence on allogeneic blood are becoming commonplace, autologous blood salvage remains a valuable tool for perioperative blood conservation. Future studies will be needed to best determine how and when cell salvage should be utilized along with newer blood conservation measures.
在首次报道自体输血近150年后，术中血液回收已成为一种重要的血液保护方法。自体输血的主要目标是减少或避免异体红细胞输血及其相关风险和成本。自体回收血液不会引发免疫挑战及其后果，提供了更高质量、未受血液储存不良影响的红细胞，并且对于经过精心挑选的手术患者而言，使用自体回收血液可能比异体血液更具成本效益。预期失血量大的心脏、骨科和血管外科手术显然可从使用血液回收中受益。在存在严重细菌污染的情况下存在安全问题。在产科和癌症手术中存在理论上的安全问题；然而，在这些情况下，仔细的细胞洗涤以及白细胞滤除可实现更安全的自体输血。需要进一步研究以确定癌症手术期间输注回收血液是否会影响肿瘤学结局。在这个患者血液管理的新时代，减少对异体血液依赖的多模式方法正变得越来越普遍，自体血液回收仍然是围手术期血液保护的一项宝贵工具。未来需要开展研究，以最佳地确定应如何以及何时将血液回收与更新的血液保护措施一起使用。
