Monk T G, Goodnough L T
Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
Am J Surg. 1995 Dec;170(6A Suppl):69S-73S. doi: 10.1016/s0002-9610(99)80063-4.
Analysis of the net costs, efficacy, and cost-effectiveness of preoperative autologous blood donation (PAD), versus acute normovolemic hemodilution (ANH), in patients undergoing radical prostatectomy is presented. Currently, PAD is a standard of care for patients undergoing radical prostatectomy. Comparison of PAD with ANH showed no differences in risks or outcome, but ANH was less expensive. Hemodilution is a simple, safe, convenient, and effective alternative to PAD. The use of recombinant human erthropoietin in conjunction with PAD and ANH has optimized perioperative hematocrits and further minimized exposure to allogeneic blood. Intraoperative blood salvage, lower transfusion triggers, and other blood conservation strategies are discussed. The most cost-effective techniques currently available for decreasing allogeneic blood transfusions appear to be avoidance of blood loss, increased tolerance for decreased HCT levels, and autologous blood procurement via ANH.
本文介绍了对接受根治性前列腺切除术的患者进行术前自体血捐献（PAD）与急性等容血液稀释（ANH）的净成本、疗效和成本效益分析。目前，PAD是接受根治性前列腺切除术患者的护理标准。PAD与ANH的比较显示，风险或结果无差异，但ANH成本更低。血液稀释是一种简单、安全、方便且有效的PAD替代方法。重组人促红细胞生成素与PAD和ANH联合使用可优化围手术期血细胞比容，并进一步减少异体血暴露。还讨论了术中血液回收、更低的输血触发阈值及其他血液保护策略。目前可用于减少异体输血的最具成本效益的技术似乎是避免失血、提高对血细胞比容水平降低的耐受性以及通过ANH采集自体血。
