Kelley-Patteson C, Ammar A D, Kelley H
Department of Surgery, University of Kansas School of Medicine, Wichita.
J Vasc Surg. 1993 Aug;18(2):261-5.
The purpose of this study was to attempt to identify a group of patients undergoing infrarenal aortic bypass in whom blood loss is consistently less than 2 units, making the routine use of autotransfusion devices unnecessary.
Four groups of patients were prospectively studied as follows: abdominal aortic aneurysm (AAA) repair with tube graft (n = 21), AAA repair with bifemoral or biiliac bypass (n = 19), and aortobifemoral bypass (AFB) or biiliac bypass for occlusive disease either with Cell Saver Autotransfusion Device (Haemonetics Corp., Braintree, Mass.) (n = 18) or without Cell Saver (n = 18). The latter two groups were randomized on an alternating basis.
The following parameters were obtained on all patients: preoperative hemoglobin values, estimated blood loss, Cell Saver return volumes, intraoperative and postoperative homologous blood transfused, postoperative hemoglobin values on the day of surgery and on postoperative days 1 and 4, complications, and length of hospital stay. In comparing the groups undergoing AFB with Cell Saver and AFB without Cell Saver by the above parameters, we found no statistically significant differences, except for a higher hemoglobin level on postoperative day 1 in the group undergoing AFB with Cell Saver (mean 11.86 vs 10.74, p = 0.02). The estimated blood loss and Cell Saver return volumes were less for those patients undergoing AFB for occlusive disease compared with those undergoing AFB for aneurysmal disease. Interestingly, estimated blood loss and Cell Saver return volumes for patients with AAA with tube graft and patients undergoing AFB with Cell Saver were similar.
We conclude that routine setup and use of rapid autotransfusion devices may not be necessary in every patient undergoing routine aortofemoral bypass for occlusive disease. Furthermore, the possibility that some patients may undergo AAA repair with tube grafts without use of the Cell Saver may be deserving of further investigation.
本研究旨在试图确定一组接受肾下腹主动脉搭桥手术的患者，其失血量始终少于2单位，从而无需常规使用自体输血装置。
前瞻性地研究了四组患者，如下所示：采用管状移植物修复腹主动脉瘤（AAA）（n = 21），采用双股或双侧髂动脉搭桥修复AAA（n = 19），以及采用细胞回收自体输血装置（Haemonetics公司，马萨诸塞州布伦特里）（n = 18）或不使用细胞回收装置（n = 18）进行闭塞性疾病的主动脉双股搭桥（AFB）或双侧髂动脉搭桥。后两组交替随机分组。
记录了所有患者的以下参数：术前血红蛋白值、估计失血量、细胞回收装置回输量、术中及术后输注的异体血、手术当天及术后第1天和第4天的术后血红蛋白值、并发症及住院时间。通过上述参数比较接受使用细胞回收装置的AFB组和不使用细胞回收装置的AFB组，我们发现除了使用细胞回收装置的AFB组术后第1天血红蛋白水平较高（均值11.86对10.74，p = 0.02）外，无统计学显著差异。与因动脉瘤疾病接受AFB的患者相比，因闭塞性疾病接受AFB的患者估计失血量和细胞回收装置回输量较少。有趣的是，采用管状移植物修复AAA的患者和接受使用细胞回收装置的AFB的患者的估计失血量和细胞回收装置回输量相似。
我们得出结论，对于每一位接受常规闭塞性疾病主动脉股动脉搭桥手术的患者，可能无需常规设置和使用快速自体输血装置。此外，一些患者可能在不使用细胞回收装置的情况下采用管状移植物修复AAA，这一可能性值得进一步研究。
