Borghi B, Pignotti E, Montebugnoli M, Bassi A, Corbascio M, de Simone N, Elmar K, Righi U, Laguardia A M, Bugamelli S, Cataldi F, Ranocchi R, Feoli M A, Bombardini T, Gargioni G, Franchini A G, Caroli G C
1st Service of Anaesthesia and Intensive Care, IRCCS, Rizzoli Orthopaedic Institute, Bologna, Italy.
Br J Anaesth. 1997 Nov;79(5):662-4. doi: 10.1093/bja/79.5.662.
Using a prospective audit, we have evaluated the efficacy of an integrated autotransfusion regimen which comprised predepositing and intra- and postoperative blood salvage in major orthopaedic surgery. We examined prospectively the records of 1785 patients (1198 females, 5867 males, mean age 62 (range 16-90) yr, preoperative haemoglobin concentration 13.4 (SD 1.4) g dl-1) undergoing total hip arthroplasty (THA, 1229 patients), THA after removal of internal fixation devices (RFD + THA, 18 patients), total knee arthroplasty (TKA, 263 patients), revision surgery of the hip (HR cup + stem revision, 197 patients; cup revision, 53 patients; stem revision, 16 patients) and total knee revision (TKR, nine patients). We estimated that the number of predonations (MSBOS = maximum surgery blood order schedule) was 2 u. for THA, TKA and TKR, and 3 u. for partial or total hip revision and total hip arthroplasty with fixation removal. We found that it was possible to obtain the MSBOS in 1597 patients (89.5%). Homologous red blood cell (HRBC) transfusions were carried out in 131 patients (7.3%). We found that the need to use HRBC was significantly associated with failure to meet the number of MSBOS, female sex, lower preoperative haemoglobin concentration, use of calcium heparin for antithrombosis prophylaxis, more extensive surgery, higher ASA rating and co-existing diseases such as coronary artery disease.
我们采用前瞻性审计，评估了一种综合自体输血方案的疗效，该方案包括在大型骨科手术中进行术前预存式自体输血以及术中、术后血液回收。我们前瞻性地检查了1785例患者（1198例女性，5867例男性，平均年龄62岁（范围16 - 90岁），术前血红蛋白浓度为13.4（标准差1.4）g/dl）的记录，这些患者接受了全髋关节置换术（THA，1229例）、取出内固定装置后行全髋关节置换术（RFD + THA，18例）、全膝关节置换术（TKA，263例）、髋关节翻修手术（HR杯 + 柄翻修，197例；杯翻修，53例；柄翻修，16例）以及全膝关节翻修术（TKR，9例）。我们估计，对于THA、TKA和TKR，术前预存式自体输血的单位数（MSBOS = 最大手术用血预定计划）为2单位；对于部分或全髋关节翻修以及取出内固定装置的全髋关节置换术，为3单位。我们发现，1597例患者（89.5%）能够达到MSBOS。131例患者（7.3%）接受了异体红细胞（HRBC）输血。我们发现，使用HRBC的需求与未达到MSBOS的数量、女性性别、术前血红蛋白浓度较低、使用钙肝素进行抗血栓预防、手术范围更广、ASA评分较高以及存在如冠状动脉疾病等并存疾病显著相关。
