Biesma D H, van Iperen C E, Kraaijenhagen R J, Marx J J, van de Wiel H B, van de Wiel A
Department of Internal Medicine, University Hospital Utrecht, The Netherlands.
Vox Sang. 1994;66(4):270-5. doi: 10.1111/j.1423-0410.1994.tb00328.x.
To evaluate changes in the need for homologous blood and to assess the impact of autologous blood transfusion, red cell transfusions in unilateral total hip replacement surgery, performed electively in the period 1986-1991, were studied in a regional hospital. Transfusion data, perioperative blood loss and post-operative haemoglobin concentration of 495 patients were analysed. From 1986 to 1991, the percentage of patients not transfused with homologous blood increased from 18.5 to 45.5%. After the introduction of an autologous blood transfusion programme in 1987, 116 of 430 patients (27.0%) donated autologous blood. No increase in the percentage of autologous donors was observed during the study. Most common reasons for nonparticipation were the patient's age, doctors' underordering and logistic limitations. 81.9% of autologous donors had total hip replacement surgery without homologous transfusions. Mean blood loss reduced significantly from 1,373 +/- 781 ml in 1986 to 958 +/- 582 ml in 1991 (p < 0.001). Transfusion requirement in the nonautologous patients fell from 2.6 +/- 1.8 units in 1986 to 1.4 +/- 1.4 units per patient in 1989 and increased thereafter to 2.2 +/- 2.1 units in 1991 (p < 0.01) and showed a strong correlation with blood loss (r = 0.58; p < 0.001). No changes in postoperative haemoglobin concentration were observed throughout the study. In conclusion, collection of autologous blood is effective, albeit still underutilized, to reduce homologous blood requirement. The close correlation between blood loss and transfusion requirement accentuates the role of surgical practice in the reduction of homologous transfusions.
为评估对同源血需求的变化，并评估自体输血的影响，我们在一家地区医院对1986年至1991年期间择期进行的单侧全髋关节置换手术中的红细胞输血情况进行了研究。分析了495例患者的输血数据、围手术期失血量和术后血红蛋白浓度。从1986年到1991年，未输注同源血的患者比例从18.5%增至45.5%。1987年引入自体输血计划后，430例患者中有116例（27.0%）捐献了自体血。研究期间自体血捐献者比例未见增加。不参与的最常见原因是患者年龄、医生医嘱不足和后勤限制。81.9%的自体血捐献者进行全髋关节置换手术时未输注同源血。平均失血量从1986年的1373±781毫升显著降至1991年的958±582毫升（p<0.001）。非自体输血患者的输血需求量从1986年的2.6±1.8单位降至1989年的每位患者1.4±1.4单位，随后在1991年增至2.2±2.1单位（p<0.01），且与失血量呈强相关（r=0.58；p<0.001）。研究期间术后血红蛋白浓度未见变化。总之，采集自体血在减少同源血需求方面是有效的，尽管仍未得到充分利用。失血量与输血需求量之间的密切相关性凸显了手术操作在减少同源输血中的作用。
