Goobie Susan M, Faraoni David
Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Arthur S. Keats Division of Pediatric Cardiovascular Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
Br J Anaesth. 2025 Jan;134(1):168-179. doi: 10.1016/j.bja.2024.08.034. Epub 2024 Oct 24.
Patient blood management (PBM) encompasses implementing multimodal evidence-based strategies to screen, diagnose, and properly treat anaemia and coagulopathies using goal-directed therapy while minimising bleeding. The aim of PBM is to improve clinical care and patient outcomes while managing patients with potential or ongoing critical anaemia, clinically significant bleeding, and coagulopathies. The focus of PBM is patient-centred rather than transfusion-centred. Multimodal PBM strategies are now recommended by international organisations, including the World Health Organization, as a new standard of care and a proven means to safely and effectively manage anaemia and blood loss while minimising unnecessary blood transfusion. Compared with adult PBM, paediatric PBM is currently not routinely accepted as a standard of care. This is partly because of the paucity of robust data on paediatric patient PBM. Managing paediatric bleeding and blood product transfusion presents unique challenges. Neonates, infants, children, and adolescents each have specific considerations based on age, weight, physiology, and pharmacology. This narrative review covers the latest updates for PBM in paediatric surgical populations including the benefits and principles of paediatric PBM, current expert consensus guidelines, and important universal multimodal therapeutic strategies emphasising clinical management of the anaemic, bleeding, or coagulopathic paediatric patient in the perioperative period. Practical paediatric rules for PBM in the perioperative period are highlighted, with review of specific PBM strategies including treatment of preoperative anaemia, restrictive transfusion thresholds, antifibrinolytic agents, cell salvage, standardised transfusion algorithms, and goal-directed therapy based on point-of-care and viscoelastic testing.
患者血液管理（PBM）包括实施多模式循证策略，以筛查、诊断并使用目标导向治疗妥善治疗贫血和凝血障碍，同时尽量减少出血。PBM的目标是改善临床护理和患者预后，同时管理患有潜在或持续性严重贫血、具有临床意义的出血和凝血障碍的患者。PBM的重点是以患者为中心，而非以输血为中心。包括世界卫生组织在内的国际组织现在推荐多模式PBM策略，将其作为一种新的护理标准以及安全有效地管理贫血和失血同时尽量减少不必要输血的已证实方法。与成人PBM相比，儿科PBM目前尚未被常规接受为护理标准。部分原因是关于儿科患者PBM的有力数据匮乏。管理儿科出血和血液制品输血带来了独特的挑战。新生儿、婴儿、儿童和青少年基于年龄、体重、生理学和药理学各有特定的考虑因素。本叙述性综述涵盖了儿科手术人群中PBM的最新进展，包括儿科PBM的益处和原则、当前专家共识指南，以及强调围手术期贫血、出血或凝血障碍儿科患者临床管理的重要通用多模式治疗策略。突出了围手术期儿科PBM的实用规则，并回顾了特定的PBM策略，包括术前贫血的治疗、限制性输血阈值、抗纤溶药物、细胞回收、标准化输血算法，以及基于即时检测和粘弹性检测的目标导向治疗。
