Nobre Layana Vieira, Garcia Luis Vicente
Universidade de São Paulo, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor pelo Programa de Pós-Graduação em Ciências da Saúde Aplicadas ao Aparelho Locomotor, Ribeirão Preto, SP, Brasil.
Universidade de São Paulo, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Ribeirão Preto, SP, Brasil.
Braz J Anesthesiol. 2020 May-Jun;70(3):209-214. doi: 10.1016/j.bjan.2019.12.014. Epub 2020 May 12.
The study assessed the role of acute hemodilution in the blood transfusion rate in patients submitted to surgical treatment of scoliosis.
Retrospective observational study performed at Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (HC-FMRP–USP). Medical charts of patients submitted to elective correction of scoliosis between January 1996 and December 2016 were analyzed. Variables assessed were: age, weight, sex, presence of comorbidities, data regarding anesthesia and surgery, lab data, adverse events and blood transfusion rate. The final sample consisted of 33 procedures performed by the same anesthesiologist and same surgeon, divided into two groups: Hemodilution Group (n = 16) and Control Group (n = 17). Indication of acute normovolemic hemodilution was determined by patient refusal of blood transfusion for religious reasons.
The sample was statistically homogeneous and the groups were compared in terms of the attributes analyzed. The volume of homologous blood used by the Hemodilution Group was significantly lower than the Control Group ( = 0.0016). The percentage of patients who required transfusion was 12.5% in the Hemodilution Group, while it was 70.69% ( = 0.0013) in the Control Group. Upon hospital discharge, mean values of hemoglobin and hematocrit between groups did not present significant differences ( = 0.0679; = 0.1027, respectively).
Acute normovolemic hemodilution, in scoliosis correction surgeries, reduces blood transfusion rates, meeting patient needs without increasing adverse events or infection rates.
本研究评估急性血液稀释在接受脊柱侧弯手术治疗患者输血率中的作用。
在圣保罗大学医学院里贝朗普雷图临床医院（HC-FMRP–USP）进行回顾性观察研究。分析了1996年1月至2016年12月期间接受择期脊柱侧弯矫正手术患者的病历。评估的变量包括：年龄、体重、性别、合并症情况、麻醉和手术数据、实验室数据、不良事件和输血率。最终样本包括由同一位麻醉医生和同一位外科医生实施的33例手术，分为两组：血液稀释组（n = 16）和对照组（n = 17）。急性等容血液稀释的指征由因宗教原因拒绝输血的患者确定。
样本在统计学上具有同质性，并根据分析的属性对两组进行了比较。血液稀释组使用的同源血量明显低于对照组（P = 0.0016）。血液稀释组需要输血的患者百分比为12.5%，而对照组为70.69%（P = 0.0013）。出院时，两组之间血红蛋白和血细胞比容的平均值没有显著差异（分别为P = 0.0679；P = 0.1027）。
在脊柱侧弯矫正手术中，急性等容血液稀释可降低输血率，满足患者需求，且不增加不良事件或感染率。
