Hardy J F, Bélisle S, Janvier G, Samama M
Department of Anesthesia, Montreal Heart Institute, University of Montreal, Quebec, Canada.
Ann Thorac Surg. 1996 Dec;62(6):1935-43. doi: 10.1016/s0003-4975(96)00939-3.
Various strategies have been proposed to decrease bleeding and allogeneic transfusion requirements during and after cardiac operations. This article attempts to document the usefulness, or lack thereof, of the nonpharmacologic methods available in clinical practice.
Blood conservation methods were reviewed in chronologic order, as they become available to patients during the perisurgical period. The literature in support of or against each strategy was reexamined critically.
Avoidance of preoperative anemia and adherence to published guidelines for the practice of transfusion are of paramount importance. Intraoperatively, tolerance of low hemoglobin concentrations and use of autologous blood (predonated or harvested before bypass) will reduce allogeneic transfusions. The usefulness of plateletpheresis and retransfusion of shed mediastinal fluid remains controversial. Intraoperatively and postoperatively, maintenance of normothermia contributes to improved hemostasis.
Several approaches have been shown to be effective. An efficient combination of methods can reduce, and sometimes abolish, the need for allogeneic blood products after cardiac operations, inasmuch as all those involved in the care of cardiac surgical patients adhere thoughtfully to existing transfusion guidelines.
人们已经提出了各种策略来减少心脏手术期间及术后的出血和异体输血需求。本文试图记录临床实践中可用的非药物方法的有效性或缺乏有效性。
按照血液保护方法在围手术期提供给患者的时间顺序进行回顾。对支持或反对每种策略的文献进行了严格重新审视。
避免术前贫血并遵守已公布的输血实践指南至关重要。术中，耐受低血红蛋白浓度并使用自体血（在体外循环前预存或采集）将减少异体输血。血小板单采术和回输纵隔引流液的有效性仍存在争议。术中和术后，维持正常体温有助于改善止血。
已证明几种方法是有效的。如果所有参与心脏外科患者护理的人员都认真遵守现有的输血指南，那么有效的方法组合可以减少，有时甚至消除心脏手术后对异体血液制品的需求。
