成人心血管手术回收式自体输血与异体红细胞输注的关系

Association between cell salvage and allogeneic red blood transfusion in adult cardiovascular surgery

目的探讨成人心血管外科手术回收式自体输血与异体红细胞输注的关系。方法选取2008年1月至2018年12月中国医学科学院阜外医院收治的心血管外科手术患者93014例,按年度比较分析患者一般资料、手术例数、回收式自体输血使用率及回收红细胞量、异体红细胞输注率及用量。结果与2008年比较,2018年成人心血管外科手术量增长136.6%(10891例比4603例),回收式自体输血使用率增长196.0%(89.1%比30.1%),异体红细胞输注率降低65.4%(24.4%比70.5%,P<0.01),平均异体红细胞用量降低64.7%([1.2±0.5)U比(3.4±1.8)U,P<0.01),异体红细胞输注率(用量)随着回收式自体输血使用率的增加而下降(P<0.001),当回收式自体输血使用率达到90%时,异体红细胞输注不再继续降低,而维持在稳定水平。结论回收式自体输血技术可显著减少成人心血管外科手术患者异体红细胞输注,当使用率达到90%时其降低异体红细胞输注效力减弱,需联合应用其他血液管理措施以进一步减少异体红细胞输注。

Objective To evaluate the relationship between intra-operative cell salvage and allogeneic RBC transfusion in adult patients undergoing cardiovascular surgery.Methods Continuous adult cardiovascular surgical procedures from January 2008 to December 2018 were reviewed.The demographic data,the number of surgical cases,intra-operative cell salvage and the amount of salvaged RBC,allogeneic RBC transfusion were documented.All data were analyzed by year.Results A total of 93014 cases of cardiovascular surgery were enrolled.Compared with 2008,the number of surgical cases increased by136.6%(10891 vs.4603)in 2018,the usage of cell salvage increased by 196.0%(89.1%vs.30.1%),the incidence of allogeneic RBC transfusion decreased by 65.4%(24.4%vs.70.5%,P<0.01),and the average amount of allogeneic RBC used by surgical patients decreased by 64.7%[(1.2±0.5)U vs.(3.4±1.8)U,P<0.01].The incidence of allogeneic RBC transfusion decreased significantly with increasing usage of cell salvage(P<0.001),when the utilization rate of intra-operative cell salvage reached a certain level(90%),the rate of allogeneic RBC transfusion did not decline further and remained at a stable level.Conclusions Intra-operative cell salvage can significantly reduce the incidence of allogeneic RBC transfusion in adult patients undergoing cardiovascular surgery,however its effectiveness of reducing allogeneic RBC transfusion is weakened when the utilization rate of intra-operative cell salvage reaches a certain level(90%),other blood management measures should be combined to further reduce allogeneic RBC transfusion.