Schmied H, Schiferer A, Sessler D I, Meznik C
Department of Anesthesiology, The General Hospital of Amstetten, Austria.
Anesth Analg. 1998 Feb;86(2):387-91. doi: 10.1097/00000539-199802000-00032.
Since 1993, we have progressively adopted three techniques to reduce transfusion requirements during major orthopedic surgery: red-cell scavenging, acute normovolemic hemodilution, and active patient warming. We retrospectively evaluated all 821 elective hip and knee arthroplasties performed in our institution beginning with July 1993. Target minimal hematocrits were guided by patient ages and cardiovascular status. The first approximately 500-mL blood loss was replaced with crystalloid at a ratio of 3 mL for each milliliter of blood loss. Additional blood loss was replaced with colloid, hemodilution blood (when available), and scavenged red cells (when available). Allogenic transfusions were then administered as necessary to maintain target hematocrits, which were prospectively defined based on the patient ages and cardiovascular health. Univariate analysis was applied initially. Significant predictors of transfusion requirement were subsequently entered into a stepwise multiple regression to account for confounding factors, including age, type of anesthesia (regional versus general) and type of surgery (primary versus hardware replacement). Postoperative hemoglobin concentrations were similar over the years of study and among the patients given each treatment. During the study period, allogenic blood requirements decreased from 1.3 +/- 1.7 U/patient to 0.6 +/- 1.4 U/patient (mean +/- SD). Both univariate and regression analyses indicated that each treatment significantly reduced transfusion requirements (P < 0.05). We conclude that red-cell scavenging, hemodilution, and active cutaneous warming each reduce allogenic blood requirements during hip and knee arthroplasties.
We retrospectively evaluated three strategies to reduce overall blood loss: red-cell scavenging, acute normovolemic hemodilution, and active patient warming. During the study period, allogenic blood requirements decreased by a factor of 2. Each treatment contributed to this reduction. We therefore conclude that each treatment reduces allogenic blood requirements during hip and knee arthroplasties.
自1993年以来，我们逐步采用了三种技术来减少大型骨科手术期间的输血需求：红细胞回收、急性等容血液稀释和患者主动保暖。我们回顾性评估了自1993年7月起在本机构进行的所有821例择期髋关节和膝关节置换术。目标最低血细胞比容根据患者年龄和心血管状况来指导。最初约500毫升的失血以每毫升失血3毫升晶体液的比例进行补充。额外的失血则用胶体液、稀释血液（如有）和回收的红细胞（如有）进行补充。然后根据需要输注异体血以维持目标血细胞比容，目标血细胞比容是根据患者年龄和心血管健康状况预先确定的。最初进行单因素分析。随后将输血需求的显著预测因素纳入逐步多元回归，以考虑混杂因素，包括年龄、麻醉类型（区域麻醉与全身麻醉）和手术类型（初次手术与翻修手术）。在研究的几年中以及接受每种治疗的患者中，术后血红蛋白浓度相似。在研究期间，异体血需求量从1.3±1.7单位/患者降至0.6±1.4单位/患者（均值±标准差）。单因素分析和回归分析均表明，每种治疗均显著降低了输血需求（P<0.05）。我们得出结论，红细胞回收、血液稀释和主动皮肤保暖均可减少髋关节和膝关节置换术中的异体血需求。
我们回顾性评估了三种减少总体失血的策略：红细胞回收、急性等容血液稀释和患者主动保暖。在研究期间，异体血需求量减少了一半。每种治疗都促成了这种减少。因此，我们得出结论，每种治疗均可减少髋关节和膝关节置换术中的异体血需求。
