A prospective trial of acute normovolemic hemodilution in patients undergoing primary cytoreductive surgery for advanced ovarian cancer
A prospective trial of acute normovolemic hemodilution in patients undergoing primary cytoreductive surgery for advanced ovarian cancer
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DOI：
10.1016/j.ygyno.2018.10.006
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发表时间：
2018-12-01
影响因子：
4.7
通讯作者：
Chi, Dennis S.
中科院分区：
文献类型：
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作者：
Tanner, Edward J.;Filippova, Olga T.;Chi, Dennis S.
目标。我们的目的是确定急性等容血液稀释 (ANH) 的安全性和有效性，以减少接受晚期卵巢癌初次细胞减灭术的患者对同种异体红细胞 (RBC) 输注的需求。方法。因晚期卵巢癌而接受初次细胞减灭术的患者被纳入一项评估手术时 ANH 的前瞻性试验。术中抽血至目标血红蛋白为 8.0 g/dL。根据机构指南，在术中和整个住院期间应用标准化输血方案，首先使用自体血液，然后使用异体血液。主要终点是确定术中和术后期间同种异体红细胞输注的总体比率。预定的同种异体红细胞输注率10毫米，3个（7%）残留病灶。估计失血量为 1000 mL（范围：150-2700）。 14 名患者 (34%) 在术中或术后接受了同种异体红细胞输注，达到了主要终点。没有患者在方案指南之外进行输血。 3 级并发症 (20%) 和吻合口漏 (7%) 的发生率与历史对照相似，并且符合预定的安全阈值。结论。对于接受初次细胞减灭术的晚期卵巢癌患者，与历史对照相比，ANH 似乎可以降低同种异体红细胞输注率，且不会增加围手术期并发症。有必要对该技术进行进一步评估。 (C) 2018 Elsevier Inc. 保留所有权利。
Objectives. Our objective was to determine the safety and efficacy of acute normovolemic hemodilution (ANH) to reduce the requirement for allogenic red blood cell (RBC) transfusions in patients undergoing primary cytoreduction for advanced ovarian cancer.Methods. Patients undergoing primary cytoreduction for advanced ovarian cancer were enrolled in a prospective trial assessing ANH at time of surgery. lntraoperative blood withdrawal was performed to a target hemoglobin of 8.0 g/dL. A standardized transfusion protocol first using autologous then allogenic blood was applied intraoperatively and throughout hospitalization according to institutional guidelines. The primary endpoint was to determine the overall rate of allogenic RBC transfusions in the intra- and postoperative periods. A predetermined allogenic RBC transfusion rate 10 mm, 3 (7%) residual disease. Estimated blood loss was 1000 mL (range, 150-2700). Fourteen patients (34%) received allogenic RBC transfusions intra- or postoperatively, meeting the primary endpoint. No patients were transfused outside protocol guidelines. The rate of grade 3 complications (20%) and anastomotic leaks (7%) were similar to historical controls and met predefined safety thresholds.Conclusions. For patients with advanced ovarian cancer undergoing primary cytoreductive surgery, ANH appears to reduce allogenic RBC transfusion rates versus historical controls without increasing perioperative complications. Further evaluation of the technique is warranted. (C) 2018 Elsevier Inc. All rights reserved.