Smetannikov Y, Hopkins D
Department of Anaesthesiology, Hillbrow Hospital, Joubert Park, South Africa.
Transfusion. 1996 Sep;36(9):832-5. doi: 10.1046/j.1537-2995.1996.36996420764.x.
The rationale for intraoperative blood transfusion is often based on incorrect concepts and criteria.
A mathematical model based on physiologic measures and describing the usual pattern of surgical blood loss is presented, and a theoretical means of minimizing intraoperative hemoglobin loss with hypervolemic hemodilution is proposed.
Intraoperative hemoglobin loss is often overestimated especially in connection with high-volume blood loss. The model of intraoperative hypervolemic hemodilution shows significant improvement in hemoglobin concentration in the immediate postoperative period, compared with normovolemic conditions. The difference is most marked at a high volume of blood loss and a high degree of maintained hypervolemia.
The practice of intraoperative blood transfusion according to volume of blood lost is to be discouraged, and regular monitoring of the hematocrit is necessary to avoid unnecessary transfusion. The theoretical advantages of hypervolemic hemodilution warrant further testing of the model in a clinical setting.
术中输血的理论依据往往基于错误的概念和标准。
提出了一个基于生理指标并描述手术失血通常模式的数学模型，并提出了通过高容量血液稀释将术中血红蛋白损失降至最低的理论方法。
术中血红蛋白损失常常被高估，尤其是在大量失血的情况下。与正常血容量情况相比，术中高容量血液稀释模型显示术后即刻血红蛋白浓度有显著改善。在大量失血和高度维持高血容量的情况下，差异最为明显。
应不鼓励根据失血量进行术中输血的做法，有必要定期监测血细胞比容以避免不必要的输血。高容量血液稀释的理论优势值得在临床环境中对该模型进行进一步测试。
