Kalfon F, Beaumont J L, Fournel J J, Viars P
Département d'Anesthésie-Réanimation, Groupe Hospitalier Pitié-Salpêtrière, Paris.
Ann Fr Anesth Reanim. 1994;13(6):798-806. doi: 10.1016/s0750-7658(05)80917-7.
Autologous blood transfusion techniques have been devised in order to decrease the risk of homologous transfusion-related complications. In neurosurgery, preoperative autologous blood collection is difficult because of the rather short time interval before surgery, as well as the risk of increasing cerebral oedema or intracranial hypertension. Therefore erythrocytapheresis has been performed the day before surgery as a preoperative haemodilution in 33 patients, using a discontinuous flow cell separator (PCS + Heamonetics). Patients with anaemia, unstable cardiovascular condition, infections, malignant tumor with a bad prognosis, or a poor peripheral venous status were not included. The mean volume of collected red cells was 526 +/- 176 mL, allowing a minimal colloid perfusion adjusted on this volume, with a simultaneous restitution of plasma and platelets. For a mean peroperative estimated blood loss of 1,040 +/- 52 mL, a homologous blood transfusion was avoided in 29 patients (88%). Four patients who underwent meningioma surgery received homologous red cells units in addition to their autologous blood. Two patients did not require any transfusion. Finally, 88% of autologous red cells units were readministered and 8 units were not retransfused. Preoperative erythrocytapheresis has proven to be a very simple and well tolerated technique. It can be considered for elective neurosurgery, when the time delay before surgery is short and when the blood loss is anticipated as to be moderate. It may also be associated with iterative autologous blood donation programme or the peroperative use of a cell saver.
为降低异体输血相关并发症的风险，已设计出自体输血技术。在神经外科手术中，由于术前时间间隔较短，以及增加脑水肿或颅内高压的风险，术前自体采血很困难。因此，在33例患者中，术前一天使用间断流动血细胞分离机（PCS + 贺曼奈提克斯）进行了红细胞单采术作为术前血液稀释。不包括贫血、心血管状况不稳定、感染、预后不良的恶性肿瘤或外周静脉状况不佳的患者。采集的红细胞平均体积为526±176 mL，可根据该体积调整最小胶体灌注量，同时回输血浆和血小板。对于平均术中估计失血量为1040±52 mL的情况，29例患者（88%）避免了异体输血。4例接受脑膜瘤手术的患者除自体血外还接受了异体红细胞单位输血。2例患者不需要任何输血。最后，88%的自体红细胞单位被回输，8个单位未被回输。术前红细胞单采术已被证明是一种非常简单且耐受性良好的技术。当手术前时间延迟较短且预计失血量为中等时，对于择期神经外科手术可考虑采用该技术。它也可能与迭代自体献血计划或术中使用血液回收机相关联。
