Transfusion guidelines for cardiovascular surgery: lessons learned from operations in Jehovah's Witnesses.
Transfusion guidelines for cardiovascular surgery: lessons learned from operations in Jehovah's Witnesses.
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心血管手术的输血指南：耶和华见证人手术的经验教训。
DOI：
10.1067/mva.1992.40968
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发表时间：
1992
影响因子：
4.3
通讯作者：
Vertrees,RA
中科院分区：
文献类型：
--
作者：
Spence,RK;Alexander,JB;DelRossi,AJ;Cernaianu,AD;CilleyJr,J;Pello,MJ;Atabek,U;Camishion,RC;Vertrees,RA
接受心血管手术的患者是同种输血（HBT）的主要使用者。对HBT的疾病传播和免疫系统调节风险的认识促使我们寻找替代方案，如自体献血前（APD）和术中自体输血（IAT）。然而，这些选择并不适合所有患者。我们回顾了59名耶和华见证会患者的经验，他们接受了63次择期心血管手术，没有HBT或APD，以确定没有这些模式的操作安全性，并制定了修订后的最大外科血液订购时间表指南。估计失血量平均为870 ml，但三分之一至一半的损失被IAT取代。在估计失血量小于150 ml的下肢旁路手术中不需要IAT。死亡3例（5.1%），仅1例死于手术出血并发症。我们得出结论：（1）择期心血管手术可以安全地进行，无需使用HBT或APD，（2）腿部旁路手术中不需要HBT，（3）通过使用术中自体输血和接受术后血红蛋白最低值7.0 gm/dl，可以将主要心血管手术中HBT的最大手术血液订购时间表指南降至接近零。（J Vasc Surg1992;16：825-31.）
Patients undergoing cardiovascular surgery are among the top users of homologous blood transfusion (HBT). Awareness of the risks of disease transmission and immune system modulation from HBT has prompted us to find alternatives such as autologous predonation (APD) and intraoperative autotransfusion (IAT). However, these latter options are not appropriate for all patients. We reviewed our experience with 59 Jehovah's Witness patients who underwent 63 elective cardiovascular procedures without either HBT or APD to determine the safety of operation without these modalities and to develop revised maximum surgical blood-ordering schedule guidelines for cardiovascular surgery. Estimated blood loss averaged 870 ml, but one third to one half of losses were replaced by IAT. IAT was not needed in lower extremity bypass operations in which the estimated blood loss was less than 150 ml. Three of 59 patients died (5.1%), but only one died of operative bleeding complications. We conclude that (1) elective cardiovascular operations can be done safely without the use of either HBT or APD, (2) HBT is not necessary in leg bypass procedures, and (3) maximum surgical blood-ordering schedule guidelines for HBT in major cardiovascular operations can be reduced to near zero by the use of intraoperative autotransfusion and acceptance of a postoperative hemoglobin nadir of 7.0 gm/dl. (J Vasc Surg1992;16:825–31.)