亟待打破医学藩篱——无输血医疗能否替代传统输血

Breaking Urgently Medical Barriers:Whether bloodless medicine can replace traditional blood transfusion

尽管成分输血已经在临床普遍使用,仍有一些患者因各种原因不能予以输血,拒绝输血,但这并不等于拒绝临床治疗,仍然有很多选择可以替代输血,这些策略统称为无输血医疗,其临床使用原则和输血管理基本相同,同样是循证医学为基础的先进医学观点,旨在尽可能保留患者自己的血,提高患者预后。无输血医疗技术涉及到早期临床决策、伦理思考、优化患者术前状况、去除潜在出血风险、提高患者贫血耐受力等各个方面,综合各种技术全面提高患者手术预后,避免输血。

Although allogenic blood components transfusion has been widely utilized in clinical practice,transfusion cannot be carried out in some patients for various reasons.That the patients do not accept the treatment of blood transfusion does not mean their complete rejection of any other clinical treatment,their right of life should be similarly respected whatever decision they make.However,up to today,surgery could be fulfilled by using various alternative techniques,and all these strategies are collectively defined as ＂ Bloodless Medicine and Surgery＂.Bloodless medicine which share the similar protocol and principle in its clinical application with blood transfusion,is designed to preserve patient＇s own blood to improve the outcomes of patients undergoing the surgical procedure,and evidence of evidence-based medicine currently shows its success and positive effectiveness during the surgical procedure.However,bloodless medicine,as a new alternative of blood transfusion,almost involves all the aspects in clinical practice：how to determine what components and procedures are acceptable to the patient without blood transfusion;optimizing the patient for early correction of treatable deficiencies,solving the ethnic conflict,minimizing blood loss and improving physiological responses to anemia.By comprehensive or mixed use of all these approaches,safety and outcome of patients undergoing surgery could be protected,while patients who approach to transfusions could be endangered.