Acute normovolemic hemodilution reduced allogeneic blood transfusion without increasing perioperative complications in patients undergoing free-flap reconstruction of the head and neck
Acute normovolemic hemodilution reduced allogeneic blood transfusion without increasing perioperative complications in patients undergoing free-flap reconstruction of the head and neck
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DOI：
10.1007/s00540-019-02714-5
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发表时间：
2020-04-01
影响因子：
2.8
通讯作者：
Hirota, Kazuyoshi
中科院分区：
文献类型：
--
作者：
Takekawa, Daiki;Saito, Junichi;Hirota, Kazuyoshi
目的 本病例对照研究旨在评估急性等容血液稀释（ANH）是否可以减少围手术期同种异体输血（ABT）的需要并影响头颈游离皮瓣重建围手术期并发症的发生率。方法 这项单中心、回顾性、观察性研究包括 123 例肿瘤手术后接受游离皮瓣重建头颈部的患者的围手术期数据。根据是否接受ANH将患者分为以下两组：ANH组和非ANH组。我们使用倾向评分调整逻辑回归分析研究了 ANH 是否可以减少围手术期 ABT 的需要。结果 123 名患者中，113 名患者接受了评估； ANH 组有 57 名患者，非 ANH 组有 56 名患者。 ANH 组的 ABT 发生率 [ANH 组 vs. 非 ANH 组，n (%)：2 (3.5%) vs. 23 (41.1%)，p < 0.0001] 和量 [中位数 (IQR)：0 mL (0, 0) vs. 0 mL (0, 280)，p < 0.0001] 均显着低于非 ANH 组。倾向评分调整的多元逻辑回归分析表明，ANH 的使用[比值比 (OR)：0.040； 95%置信区间（CI）0.005、0.320； p = 0.0024)] 是围手术期 ABT 的独立预测因素之一。两组术后并发症发生率无显着差异。结论 使用 ANH 可以减少头颈部游离皮瓣重建患者围术期 ABT 的需要，且不会增加术后并发症的发生率。
Purpose The present case-control study was conducted to evaluate whether acute normovolemic hemodilution (ANH) can reduce the need for perioperative allogeneic blood transfusion (ABT) and affect the incidence of perioperative complications in free-flap reconstruction of the head and neck. Methods This single-center, retrospective, observational study included the perioperative data of 123 patients who underwent free-flap reconstruction of the head and neck following oncological surgery. Patients were divided into the following two groups according to whether they received ANH: ANH group and non-ANH group. We investigated whether ANH can reduce the need for perioperative ABT using propensity score-adjusted logistic regression analysis. Results Of the 123 patients, 113 patients were assessed; 57 patients were in the ANH group and 56 patients were in the non-ANH group. The rate [ANH group vs. non-ANH group, n (%): 2 (3.5%) vs. 23 (41.1%), p < 0.0001] and amount [median (IQR): 0 mL (0, 0) vs. 0 mL (0, 280), p < 0.0001] of ABT were significantly lower in the ANH group than in the non-ANH group. Propensity score-adjusted multivariate logistic regression analysis indicated that ANH use [odds ratio (OR): 0.040; 95% confidence interval (CI) 0.005, 0.320; p = 0.0024)] was one of the independent predictors of perioperative ABT. There were no significant differences in the incidences of post-operative complications between the two groups. Conclusion ANH use can reduce the need for perioperative ABT in patients undergoing free-flap reconstruction of the head and neck without increasing the incidence of post-operative complications.