Hallfeldt K, Dornschneider G, Sohn M, Thetter O
Thoraxchirurgische Abteilung, Zentralkrankenhauses Gauting.
Zentralbl Chir. 1995;120(3):228-33; discussion 233-5.
It was the aim of the underlying study to determine the value of preoperative autologous blood donation and its importance with regard to pulmonal lobectomies. Over the course of three years and a total number of 220 operations, autologous blood was preoperatively deposited in 74 cases. 21 patients did not meet the criteria for autologous blood donation and hence, were omitted from the study. It was found that only 5.4% of the patients who had donated autologous blood required a homologous blood transfusion versus 27.2% in the non-donor group. This would imply, that the necessity for homologous blood transfusion is reduced by approximately 80% in patients depositing autologous blood prior to surgery. Observing a similar haemoglobin in both groups at admission, it was found that autologous blood donors went into surgery with an hb 1.5 g/dl lower than non donors; the levels however adjusting themselves immediately postoperatively. No increased complication rate was found as a result of preoperative autologous blood donation. The data indicate that only 30% of patients undergoing pulmonal lobectomy require homologous blood transfusions. 80% of these patients could profit from preoperative autologous blood donation. For 70% of all patients the procedure would be of no benefit. Bearing in mind the immunosuppressive effect of homologous blood transfusions, which may result in a higher rate of tumor recurrence, we find preoperative autologous blood donation a justifiable procedure even under these circumstances. It would however be beneficial if studies were conducted hereby investigating to what extent similar results could be achieved by preoperative acute isovolemic hemodilution.
本研究的目的是确定术前自体血捐献的价值及其在肺叶切除术中的重要性。在三年的时间里，总共进行了220例手术，其中74例术前进行了自体血储存。21例患者不符合自体血捐献标准，因此被排除在研究之外。结果发现，自体血捐献患者中只有5.4%需要异体输血，而非捐献组的这一比例为27.2%。这意味着，术前储存自体血的患者异体输血的必要性降低了约80%。入院时两组患者的血红蛋白水平相似，但发现自体血捐献者手术时的血红蛋白水平比非捐献者低1.5 g/dl；不过术后血红蛋白水平立即自行调整。未发现术前自体血捐献导致并发症发生率增加。数据表明，接受肺叶切除术的患者中只有30%需要异体输血。这些患者中有80%可以从术前自体血捐献中获益。对于所有患者中的70%，该程序并无益处。考虑到异体输血的免疫抑制作用可能导致更高的肿瘤复发率，即使在这种情况下，我们认为术前自体血捐献也是一种合理的程序。然而，如果开展研究调查术前急性等容血液稀释在多大程度上能取得类似结果，将会很有帮助。
