Huber T S, Carlton L C, Irwin P B, Flug R R, Harward T R, Flynn T C, Seeger J M
Department of Surgery, University of Florida College of Medicine, Gainesville 32610, USA.
J Surg Res. 1997 Jan;67(1):14-20. doi: 10.1006/jsre.1996.4971.
Intraoperative autologous transfusion devices have been purported to reduce allogenic transfusions and their associated complications. However, the value of their routine use during elective cardiovascular operations remains undefined. This study was designed to examine the efficacy of the Haemonetics Cell Saver (CS) during elective aortic reconstructions and identify predictors of clinically significant (> or = 500 cc) and cost-efficient (> or = 1250 cc) salvage volumes. The medical records of all patients undergoing elective infrarenal aortic reconstructions between January 1991 and June 1995 were retrospectively reviewed to determine blood loss, CS return, predictors of clinically significant/ cost-efficient CS returns, blood products transfused, and estimated cost per unit CS return. The CS was used for 138 (82.1%) of all reconstructions during the study period. Estimated blood loss (2127 +/- 1467 vs 1415 +/- 1047) and CS return (927 +/- 790 vs 515 +/- 408) were significantly greater in patients with aneurysms (AAA, N = 63) compared to those with aortoiliac occlusive disease (AIOD, N = 75). CS returns > or = 500 cc were common (79.4% AAA, 52.0% AIOD) and predictors of > or = 500 cc CS returns were large aneurysms (6.79 +/- 1.84 vs 5.72 +/- 0.71 cm) and male sex (82.0 vs 46.2%) in AAA patients and lower preoperative platelet counts (262 +/- 93 vs 311 +/- 113 K/mm3), concomitant renal revascularizations (20.5 vs 0%), and prolonged operative time (7.9 +/- 2.4 vs 6.9 +/- 2.1 hr) in AIOD patients. In contrast, CS returns > or = 1250 cc were relatively uncommon (28.6% AAA, 5.3% AIOD), and predictors of these CS returns were found only for AAA patients and included any concomitant vascular procedures (38.8 vs 15.6%) and the need for suprarenal aortic clamping (27.8 vs 6.7%). Despite the use of the CS, 73.8% of all patients required allogenic packed red blood cells with a mean of 3.0 +/- 3.1 units transfused in the perioperative period; no difference was seen between AAA and AIOD patients. The calculated cost for a unit of CS return was +128.77 for the AAA patients and +231.91 for the AIOD patients. Not using the CS and substituting the return with allogenic packed red blood cells would have saved +252.80 and +352.84 for the AAA and AIOD patients, respectively. Routine use of the CS during elective infrarenal aortic reconstructions is not cost efficient and should be abandoned. Use of the device should be reserved only for complex reconstruction.
术中自体输血装置据称可减少异体输血及其相关并发症。然而，其在择期心血管手术中常规使用的价值仍不明确。本研究旨在探讨Haemonetics细胞回收机（CS）在择期主动脉重建术中的疗效，并确定临床显著（≥500 cc）和成本效益高（≥1250 cc）回收量的预测因素。回顾性分析1991年1月至1995年6月期间所有接受择期肾下腹主动脉重建术患者的病历，以确定失血量、CS回收量、临床显著/成本效益高的CS回收量的预测因素、输注的血液制品以及每单位CS回收量的估计成本。在研究期间，138例（82.1%）重建手术使用了CS。与主髂动脉闭塞性疾病（AIOD，N = 75）患者相比，动脉瘤患者（AAA，N = 63）的估计失血量（2127±1467 vs 1415±1047）和CS回收量（927±790 vs 515±408）显著更高。CS回收量≥500 cc很常见（AAA患者中为79.4%，AIOD患者中为52.0%），AAA患者中CS回收量≥500 cc的预测因素为大动脉瘤（6.79±1.84 vs 5.72±0.71 cm）和男性（82.0% vs 46.2%），AIOD患者中为术前血小板计数较低（262±93 vs 311±113 K/mm3）、同期肾血管重建（20.5% vs 0%）以及手术时间延长（7.9±2.4 vs 6.9±2.1小时）。相比之下，CS回收量≥1250 cc相对少见（AAA患者中为28.6%，AIOD患者中为5.3%），仅在AAA患者中发现了这些CS回收量的预测因素，包括任何同期血管手术（38.8% vs 15.6%）以及需要进行肾上主动脉阻断（27.8% vs 6.7%）。尽管使用了CS，73.8%的患者仍需要异体浓缩红细胞，围手术期平均输注3.0±3.1单位；AAA患者和AIOD患者之间无差异。AAA患者每单位CS回收量的计算成本为128.77美元，AIOD患者为231.91美元。对于AAA和AIOD患者，不使用CS并用异体浓缩红细胞替代回收量分别可节省252.80美元和352.84美元。在择期肾下腹主动脉重建术中常规使用CS不具有成本效益，应予以放弃。该装置仅应保留用于复杂重建手术。
