心脏手术围手术期输血策略及节血措施

Perioperative Blood Transfusion Strategies and Blood Saving Measures in Cardiac Surgery

心脏外科手术出血量多,用血量占所有手术15%~20%,同时大量输血与心脏手术患者近远期不良预后密切相关。应努力降低围手术期输血的风险,以尽可能减少异体血需要量,可以改善心脏手术患者临床结局。因此,心脏手术应采取适宜的血液保护措施,有助于减少心脏手术出血量及用血量。临床工作重点转向术前贫血的检测及纠正、中止抗血小板治疗、合理输血指征、使用抗纤溶药物、体外循环新技术应用、减少体外循环预充、低血压麻醉和自体血输技术等系统的、多学科参与的血液保护措施。

Cardiac surgery has a large amount of blood loss,which accounts for 15%-20%of all operations,meanwhile,a large amount of blood transfusion is closely related to the short and long term poor prognosis of patients undergoing cardiac surgery.Efforts should be made to reduce the risk of perioperative blood transfusion in order to minimize the need for allogeneic blood,as much as possible can improve the clinical outcome of patients undergoing cardiac surgery.So also emphasize that appropriate blood protection measures should be taken during heart surgery to help reduce the amount of blood lost and consumed during heart surgery.The focus of clinical work has shifted to systematic and multidisciplinary blood protection measures including preoperative anemia detection and correction,suspension of antiplatelet therapy,reasonable indication of blood transfusion,use of antifibrinolytic drugs,application of new extracorporeal circulation technologies,reduction of extracorporeal circulation prefilling,hypotension anesthesia and autologous blood transfusion.