Adjepong Kwame Ofori, Otegbeye Folashade, Adjepong Yaw Amoateng
Warren Alpert Medical School, Brown University, United States.
Case Western Reserve University, University Hospitals Cleveland Medical Center, United States.
Mediterr J Hematol Infect Dis. 2018 May 1;10(1):e2018032. doi: 10.4084/MJHID.2018.032. eCollection 2018.
Over 30 million people worldwide have sickle cell disease (SCD). Emergent and non-emergent surgical procedures in SCD have been associated with relatively increased risks of peri-operative mortality, vaso-occlusive (painful) crisis, acute chest syndrome, post-operative infections, congestive heart failure, cerebrovascular accident and acute kidney injury. Pre-operative assessment must include a careful review of the patient's known crisis triggers, baseline hematologic profile, usual transfusion requirements, pre-existing organ dysfunction and opioid use. Use of preoperative blood transfusions should be selective and decisions individualized based on the baseline hemoglobin, surgical procedure and anticipated volume of blood loss. Intra- and post-operative management should focus on minimizing hypoxia, hypothermia, acidosis, and intravascular volume depletion. Pre- and post-operative incentive spirometry use should be encouraged.
全球有超过3000万人患有镰状细胞病（SCD）。SCD患者进行急诊和非急诊手术时，围手术期死亡率、血管闭塞（疼痛）危象、急性胸部综合征、术后感染、充血性心力衰竭、脑血管意外和急性肾损伤的风险相对增加。术前评估必须仔细审查患者已知的危象触发因素、基线血液学指标、通常的输血需求、既往存在的器官功能障碍和阿片类药物使用情况。术前输血应具有选择性，并根据基线血红蛋白、手术方式和预期失血量进行个体化决策。术中和术后管理应侧重于尽量减少缺氧、体温过低、酸中毒和血管内容量耗竭。应鼓励术前和术后使用激励肺活量测定法。
