Steinbicker Andrea U
Department of Anesthesia, Intensive Care and Pain Medicine, University Hospital Muenster, University of Muenster, Muenster, Germany.
Curr Opin Anaesthesiol. 2019 Feb;32(1):64-71. doi: 10.1097/ACO.0000000000000671.
Anemia can contribute negatively to a patient's morbidity and mortality. Which treatment options do exist and what role do anesthesiologists play in management of perioperative anemia treatment? This review gives an overview about recent findings.
Patient Blood Management and standards for the management and treatment of anemia have been established worldwide. Various logistic settings and approaches are possible. With a special focus on cardiovascular anesthesia, intravenous iron is a therapeutic option in the preoperative setting. Autologous blood salvage is a standard procedure during surgery. Restrictive transfusion triggers in adult cardiac surgery have been shown to be beneficial in the majority of studies. Elderly patients and defined comorbidities might require higher transfusion triggers. Both, intravenous and oral iron increase hemoglobin values when given prior to surgery. Oral iron is effective when given several weeks prior to elective surgery. Erythropoietin is a treatment decision individualized to each patient.
Within the previous 18 months, important publications have demonstrated the established role of anesthesiologists in managing perioperative anemia. A substantial pillar for anemia treatment is the implementation of Patient Blood Management worldwide.
贫血会对患者的发病率和死亡率产生负面影响。目前有哪些治疗选择，麻醉医生在围手术期贫血治疗管理中扮演什么角色？本综述概述了近期的研究发现。
患者血液管理以及贫血管理和治疗的标准已在全球范围内确立。有多种后勤设置和方法可供选择。特别关注心血管麻醉领域，静脉注射铁剂是术前的一种治疗选择。自体血回收是手术期间的标准操作。大多数研究表明，成人心脏手术中采用限制性输血触发阈值是有益的。老年患者和特定的合并症可能需要更高的输血触发阈值。术前给予静脉铁剂和口服铁剂均可提高血红蛋白值。在择期手术前几周给予口服铁剂是有效的。促红细胞生成素是一种根据每个患者情况个体化的治疗决策。
在过去18个月里，重要的出版物证明了麻醉医生在管理围手术期贫血方面的既定作用。全球范围内实施患者血液管理是贫血治疗的一个重要支柱。
