Eeles Alex, Baikady Ravishankar Rao
Department of Anaesthesia The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK.
Indian J Anaesth. 2017 Jun;61(6):456-462. doi: 10.4103/ija.IJA_341_17.
Anaemia and allogeneic blood transfusions in surgical patients are associated with poor outcomes. Patient blood management (PBM) has been developed as an evidence-based clinical tool, by which clinicians can optimise anaemia, manage peri-operative bleeding, avoid unnecessary blood transfusion and improve patient outcome. This article aims to highlight the recent updates regarding evidence-based PBM in the perioperative period, following a thorough literature review involving original research articles, published guidelines and consensus documents discovered through an extensive PubMed and Medline search. PBM addresses three main pillars of the patient's journey through the pre-operative, intra-operative and post-operative periods. PBM encourages a restrictive approach to transfusion of blood products and promotes alternatives to blood transfusion to maximise clinical efficacy while minimising risks. Anaemia has been identified as an independent risk factor for poor outcomes. PBM highlights the importance of treating anaemia in the pre-operative period. Major elective surgery may be postponed until anaemia is corrected preoperatively. The intra-operative approach to PBM is a collaborative effort between the anaesthesia, surgery and transfusion laboratory teams. Use of tranexamic acid, meticulous haemostasis and cell salvage techniques play an important role during the intra-operative management of surgical and traumatic haemorrhage. Point-of-care coagulation tests with visco-elastographic methods and haemoglobin measurement ensure that the transfusion prescription is tailored to a patient. In the post-operative period, PBM highlights the need for patients to be optimised before discharge from the hospital. Implementation of the PBM has been shown to have individual health as well as economic benefits.
外科患者的贫血和异体输血与不良预后相关。患者血液管理（PBM）已发展成为一种循证临床工具，临床医生可借此优化贫血状况、管理围手术期出血、避免不必要的输血并改善患者预后。本文旨在通过全面的文献综述，突出围手术期循证PBM的最新进展，该综述涉及通过广泛的PubMed和Medline搜索发现的原创研究文章、已发表的指南和共识文件。PBM涵盖患者术前、术中和术后三个主要阶段。PBM鼓励对血液制品输血采取限制性方法，并推广输血替代方法，以在将风险降至最低的同时最大化临床疗效。贫血已被确定为不良预后的独立危险因素。PBM强调术前治疗贫血的重要性。大型择期手术可能会推迟，直到术前贫血得到纠正。PBM的术中方法是麻醉、手术和输血实验室团队之间的协作努力。使用氨甲环酸、细致止血和细胞回收技术在手术和创伤性出血的术中管理中发挥重要作用。采用黏弹性方法的即时凝血检测和血红蛋白测量可确保输血处方适合患者。在术后阶段，PBM强调患者在出院前需要进行优化。已证明实施PBM具有个体健康以及经济效益。
