Glazier D B, Ciocca R G, Gosin J S, Murphy D P, Graham A M
Division of Vascular Surgery, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick 08903-0019, USA.
Am Surg. 1998 Feb;64(2):171-4.
It has been a historical supposition that aortic surgery, even in an elective setting, has been associated with the transfusion of large amounts of blood products. We feel that this assumption is now dated, and in fact far fewer patients now receive allogenic blood products. To assess this assumption, we carried out a retrospective chart review of all patients who underwent elective aortic surgery over an 18-month period from April 1994 to October 1995. Factors analyzed included type of procedure, blood loss, amount of Cell Saver blood replaced, need for autologous blood transfusion, and need for allogenic blood transfusion. Sixty-seven patients underwent elective aortic surgery with either an aortic tube graft (23), an aortobiiliac graft (25), or an aortobifemoral graft (19). The male:female ratio was 48:19, with a mean age of 67 years (range, 42-85 years). Mortality and morbidity were 4.4 per cent and 8.9 per cent, respectively. The average blood loss per patient was 770 cc. Cell saver was used in 65 patients, with the average amount of blood returned being 542 cc. Overall, 73 per cent of patients did not require allogenic blood transfusion, and 58 per cent did not need any type of transfusion. Of those who stored autologous blood prior to operation, none required allogenic blood perioperatively. With the new advances in autologous blood transfusion both by predeposit and salvage transfusion, we have greatly reduced the need for transfusion of allogenic blood products in patients undergoing major aortic surgery. This is reassuring, and although increasing short-term cost, will reduce the morbidity-infectious, noninfectious, and immunologic-associated in prior decades with allogenic blood transfusions. We strongly recommend the use of Cell Saver techniques, and also, where possible, patients should be encouraged to donate their own blood prior to major aortic procedures for future transfusion.
一直以来存在一种历史假设，即主动脉手术，即使是在择期情况下，也一直与大量输血制品的输注相关。我们认为这种假设现在已经过时了，事实上现在接受异体输血制品的患者要少得多。为了评估这一假设，我们对1994年4月至1995年10月这18个月期间接受择期主动脉手术的所有患者进行了回顾性病历审查。分析的因素包括手术类型、失血量、细胞回收器回输的血量、自体输血需求和异体输血需求。67例患者接受了择期主动脉手术，其中行主动脉管状移植物置换术（23例）、主动脉双髂动脉移植物置换术（25例）或主动脉双股动脉移植物置换术（19例）。男女比例为48:19，平均年龄67岁（范围42 - 85岁）。死亡率和发病率分别为4.4%和8.9%。每位患者的平均失血量为770毫升。65例患者使用了细胞回收器，回输的平均血量为542毫升。总体而言，73%的患者不需要异体输血，58%的患者不需要任何类型的输血。在术前储存自体血的患者中，围手术期均无需异体输血。随着自体输血在预存式和回收式输血方面的新进展，我们已大大减少了接受主动脉大手术患者对异体输血制品的需求。这令人放心，尽管会增加短期成本，但将降低前几十年因异体输血相关的感染性、非感染性和免疫性发病率。我们强烈建议使用细胞回收器技术，并且在可能的情况下，应鼓励患者在主动脉大手术前捐献自身血液以备将来输血。
