Guerra J J, Cuckler J M
American Sports Medicine Institute, Birmingham, AL 35205, USA.
Clin Orthop Relat Res. 1995 Jun(315):212-22.
The purpose of this study was to analyze the cost effectiveness of the cell saver in reducing homologous blood transfusion requirements in patients undergoing primary total hip arthroplasties. In patients who had predonated autologous blood, the addition of the cell saver neither reduced the homologous blood requirements nor the percentage of patients exposed to banked blood. In patients without predonated autologous blood, the cell saver decreased the percentage of patients exposed to banked blood by 40% and decreased the mean homologous transfusion requirement from 2.6 to 1.5 units per patient (p < 0.05). The cell saver became cost effective when 3 units of blood were salvaged. Because the cell saver reclaimed a mean of 453 ml (approximately 2 units), it was not cost effective. This analysis is confounded by the risk of exposure to blood borne potentially life-threatening pathogens. In patients undergoing elective primary hip arthroplasty, the availability of predonated autologous blood obviates the need for expensive intraoperative blood salvage techniques. If an adequate volume of autologous blood cannot be procured preoperatively, or if the clinician suspects excessive intraoperative bleeding, then using the cell saver may be justified.
本研究的目的是分析血液回收机在减少初次全髋关节置换术患者同种异体输血需求方面的成本效益。在已预先捐献自体血的患者中，使用血液回收机既未降低同种异体血的需求量，也未降低接触库存血的患者比例。在未预先捐献自体血的患者中，血液回收机使接触库存血的患者比例降低了40%，并使每位患者的平均同种异体输血需求量从2.6单位降至1.5单位（p<0.05）。当回收3单位血液时，血液回收机具有成本效益。由于血液回收机平均回收453毫升（约2单位），因此其不具有成本效益。该分析因接触血源性潜在致命病原体的风险而受到干扰。在接受择期初次髋关节置换术的患者中，预先捐献的自体血可避免使用昂贵的术中血液回收技术。如果术前无法获取足够量的自体血，或者临床医生怀疑术中出血过多，那么使用血液回收机可能是合理的。
