Rohling R G, Zimmermann A P, Haers P E, Locher M C, Major A, Sailer H F
Klinik und Poliklinik für Kiefer- und Gesichtschirurgie, Universitätsspital Zürich.
Swiss Surg. 1998;4(3):133-40.
In terms of a prospective clinical study between June 1994 and May 1996, in 204 patients undergoing maxillo-facial surgeries with a expected blood loss of more than 500 ml a protocol of bloodsaving measures was followed. By means of an additional retrospective study, the consumption of homologous blood and the amount of bloodsaving measures between June 1990 and May 1994 was evaluated. Bloodsaving measures were consisting from acute normovolemic hemodilution, controlled moderate hypotension, cell saving, preoperative autologous blood donation, and administration of rh-erythropoetine. The methoda were applied isolated as well as in combination. Special concerns were given to a stable intraoperative homeostasis and to the acceptance of a low hematocrit perioperatively. Aim of the study was to investigate if, following the protocol, even in major maxillofacial procedures homologous blood transfusions almost completely can be avoided. Out of the 204 patients in the prospective study, only 30 received homologous blood. For the period June 94 to May 96, the reduction of the number of patients receiving homologous blood in relation to the period June 90 to May 94 was 83%. The results indicate that in the years 94 to 96 twice as much patients received bloodsaving measures. These led to a reduction of homologous blood consumption for 427 units in 1990 to 56 units 1996 (p < 0.001). If three measures, i.e. normovolemic hemodilution, cell saving, and hypotension were combined, the need of blood transfusion was at the minimum level. The effective reduction of homologous blood transfusion by consequent application of bloodsaving measures can with these data obviously be demonstrated.
在1994年6月至1996年5月进行的一项前瞻性临床研究中，对204例预计失血量超过500毫升的颌面外科手术患者采用了一系列血液保护措施。通过一项额外的回顾性研究，评估了1990年6月至1994年5月期间同源血的使用情况和血液保护措施的实施量。血液保护措施包括急性等容血液稀释、控制性适度低血压、血液回收、术前自体血捐献以及重组人促红细胞生成素的应用。这些方法既可以单独应用，也可以联合应用。特别关注术中稳定的内环境稳态以及围手术期对低血细胞比容的耐受性。本研究的目的是调查按照该方案，即使在大型颌面手术中是否几乎可以完全避免同源血输血。在前瞻性研究的204例患者中，只有30例接受了同源血输血。与1990年6月至1994年5月期间相比，1994年6月至1996年5月接受同源血输血的患者数量减少了83%。结果表明，在1994年至1996年期间，接受血液保护措施的患者数量增加了一倍。这使得同源血的使用量从1990年的427单位减少到1996年的56单位（p<0.001）。如果将等容血液稀释、血液回收和低血压这三种措施联合应用，输血需求降至最低水平。通过持续应用血液保护措施有效减少同源血输血的情况，显然可以从这些数据中得到证明。
