输血并发症与围手术期血液保护

本文主要针对经输血传播的疾病和输血对免疫力的影响。综述围手术期输血的一些弊端，咱吁临床上应全面考虑病情，严格掌握输血指征，合理用血，避免一些“保险性质”及“安慰性质”的输血，并展望围手术期输血的新形式与围手术期血液保护。     

恶性肿瘤病人围手术期输血的争论

恶性肿瘤病人围手术期常需要输血治疗，除去众所周知的输血相关问题外，有关输血对免疫功能、肿瘤生长的影响也日渐引起人们的重视。目前对于恶性肿瘤病人围手术期输血仍然存在一些争论。如何做到合理输血，避免对肿瘤产生负面影响，是临床医生给病人输血前应关心的问题。     

重视输血在围手术期的合理应用

近年来随着血液传播疾病风险的增加和输血新技术的开展，输血观念正在逐渐转变。围手术期正确地运用输血技术，趋利避害，最大限度地发挥输血疗效，减少输血不良反应、并发症和血液传播疾病，是外科医师面临的课题。输血不当，不但给受血者带来伤害，甚至危及生命，医师还可能陷入医疗纠纷之中。     

围术期输血的免疫抑制与综合性血液保护

围术期输血引起机体免疫抑制，使肿瘤复发率和术后感染率增加。本文就其免疫抑制的机制、影响因素及综合性血液保护措施三方面研究状况进行综述。     

小儿外科围手术期输血

随着小儿外科手术方法的改进及各种微创技术的应用,在小儿外科临床上,需要输血的病种及输血量逐渐减少,但仍有一些小儿外科疾患需要不同量的围手术期输血.众所周知,输血可导致各种并发症和不良反应,减少围手术期输血是现代小儿外科的一个目标.本文就小儿外科围手术期输血几个有关问题进行探讨.     

胃肠道癌患者围手术期输血与术后感染

胃肠道癌患者围手术期输血与术后感染惠希增，王廷利，郑海燕胃肠道癌症患者接受外科治疗时，常需在围手术期输血，以纠正贫血、维持血容量和有利机体恢复。目前已知道输血可以抑制患者的免疫反应，增加术后感染、多器官功能衰竭、肿瘤术后复发率［１］。输血对患者所引起...     

围术斯输血对恶性肿瘤的影响

输血是肿瘤治疗中，尤其是肿瘤手术时一个重要的处理措施。但其对肿瘤生长与复发的影响不可忽视。本文综述输血影响恶性肿瘤的机理以及在各种不同类型的恶性肿瘤中输血的危险。     

心血管手术围术期减少输血及血液制品的研究

目的 为了预防经血液传播疾病，探讨心血管手术患者减少围手术期使用异体血及血液制品，方法 １９９４年７月￣１９９５年１２月，对１８９例心血管手术患者进行前瞻性研究，采用综合方法减少围术期异体血及血液制品。在不影响手术死亡率、住院天数的情况下，实验组输异体全血的量降至对照组的２７．２９％，实验组患者平均接受１．３９个献血员的血液，为对照组４．３９个的３１．６６％，实验组用血浆量仅为对照组的２．３９％，     

53例老年消化系恶性肿瘤患者围手术期的处理

回顾性分析我院1998年10月至2002年10月收治的老年消化系肿瘤手术病例53例,报告围手术期处理的体会。 临床资料 本组53例中男35例,女18例;年龄为60～87(平均70.2)岁。肿瘤     

Effect of perioperative blood transfusion on recurrence and survival in 232 primary high-grade extremity sarcoma patients

Background: Allogeneic blood transfusion (BT) has been implicated as an unfavorable factor influencing cancer recurrence and overall survival. Methods: To investigate this, 232 consecutive localized, high-grade extremity soft tissue sarcoma (STS) patients admitted between January 1, 1983, and December 31, 1989, were analyzed from our prospective database by univariable and Cox multivariable statistical methods. Results: Twenty-eight patients developed a local recurrence (LR). Factors found significantly unfavorable for the rate of developing an LR by uni- and multivariable tests were age >60 years and positive microscopic margin. Eighty-nine patients developed a distant metastasis (DM) and 72 patients died of their tumor. Median follow-up of survivors was 48 months. Unfavorable factors for DM and tumor mortality (TM) by univariable analysis included large size, deep tumor (that involved or was below the superficial fascia), positive microscopic margin, invasion of a vital structure, operative blood loss, duration of operation, and perioperative BT (whole blood or packed cells -24 to +48 h of curative operation). Multivariable analysis found large size, deep tumor, and positive margin significant independent unfavorable factors for DM and TM. The effect of BT was not a significant independent prognosticator for LR, DM, or TM by multivariable analysis (p=0.26, 0.56, 0.08, respectively), The only factor that was found to be significant in a multivariable analysis of factors contributing to postmetastasis survival was time <6 months until metastasis (p=0.008). BT had no significant impact on postmetastasis survival (p=0.42). There was a significant association between BT and deep, large tumors. As the size of deep tumors increased from <5, 5<10, 10<15, or15 cm, the amount transfused was 15, 16, 49, and 68% (p<0.00001). Also, BT was significantly (p<0.005) associated with low hematocrit at initial diagnosis, blood loss during surgery, and the length of the surgical procedure. Conclusions: These data emphasize the importance of size, depth, and margin on distant recurrence and death for localized high-grade extremity STS. In the absence of a randomized trial, the impact of allogeneic blood transfusion would appear to be due to its strong association with large size and deep tumor invasion. This study also highlights the importance of a multivariable analysis and long-term follow-up to better define this controversial question.Presented at the 46th Annual Cancer Symposium of the Society of Surgical Oncology, Los Angeles, California, March 18–21, 1993.     

Adverse effects of perioperative transfusion on patients with stage III and IV gastric cancer

BACKGROUND: The degree of immunomodulation by perioperative blood transfusion and its resultant effects on cancer surgery are a subject of controversy. We evaluated the prognostic effects of perioperative blood transfusion on gastric cancer surgery. METHODS: A total of 1710 patients who underwent curative gastrectomy for gastric cancer from 1991 to 1995 were retrospectively reviewed. Uni- and multivariate analyses of the incidence, amount, and timing of perioperative blood transfusions and a comparison of the clinicopathological features were performed. RESULTS: A higher incidence of blood transfusions was associated with female sex, large tumors, upper-body location, Borrmann type III or IV lesions, longer operations, total gastrectomies, splenectomies, and D3 or more extended lymphadenectomy. The tumors in the transfused group were more advanced in depth of invasion and nodal classification. More frequent tumor recurrences were found in the transfused group. A dose-response relationship between the amount of transfused blood and prognosis was evident. Subgroup analyses of prognosis according to stage showed significant differences in stages III and IV between the transfused and nontransfused groups. On multivariate analysis, transfusion was shown to be an independent risk factor for recurrence and poor prognosis. CONCLUSIONS: These results suggest that perioperative transfusion is an unfavorable prognostic factor. It is thus better to refrain from unnecessary blood transfusion and to give the least amount of blood to patients with gastric cancer when transfusion is inevitable, especially for those with stage III and IV gastric cancers.     

Adverse effect of splenectomy on recurrence in total gastrectomy cancer patients with perioperative transfusion

BACKGROUND: To investigate the interactions between splenectomy and perioperative transfusion in gastric cancer patients. METHODS: Medical records of 449 gastric cancer patients who had undergone total gastrectomies for curative intent between 1991 and 1995 were reviewed. The influence of splenectomy on tumor recurrence and survival both in the transfused and nontransfused patients were evaluated by univariate and multivariate analysis. RESULTS: The recurrence rate in the splenectomy group was 48.1% as compared with 22.6% in the spleen-preserved group among transfused patients (P=.001); it was 40.7% compared with 26.5% among nontransfused patients (P=.086). There was no significant difference in the mean survival between the splenectomy group and the spleen-preserved group in a subgroup analysis by stage. Multivariate analysis identified splenectomy as an independent risk factor for recurrence but not as a predictor for survival among transfused patients. CONCLUSIONS: Splenectomy does not appear to abrogate the adverse effect of perioperative transfusion on prognosis in gastric cancer patients. Moreover, it may increase postoperative recurrence in transfused patients.     

围手术期的液体治疗进展

液体治疗是围手术期的重要治疗手段.选择正确的输液和合理的治疗策略可以著降低围手术期并发症,缩短患者住院天数,改善预后.围手术期液体治疗的历史发展是一个对“选择晶体或胶体”、“选择开放或限制补液”等有争议问题不断总结、探索、论证的前进过程.在这个过程中,广大医师对具体的围手术期治疗策略有了更深层次的认识,出现了诸如目标导向性液体治疗,早期目标导向治疗、快速通道外科等临床上有显著疗效的具体治疗策略.本文对围手术期液体治疗的进展进行综述.     

Effects of perioperative blood transfusion on prognosis in early-stage cervical cancer

Background: This study was designed to evaluate the prognostic effects of transfusion on patients undergoing radical hysterectomy for early cervical cancer. Methods: This retrospective chart review analyzed 412 patients with stage IA-IIA disease, of whom 374 were evaluable. Results: Three hundred (80%) patients received transfusions and 74 (20%) did not. The clinical characteristics of the two groups were similar, with the exception that the transfused group was older. Pathologic comparisons found that microscopic parametrial disease and larger cervical lesions were more common in the transfused group. Follow-up analysis revealed no difference between the two groups in recurrence or survival. Multivariate analysis found only grade, depth of invasion, and nodal status as independent predictors of recurrence and survival. Kaplan-Meier survival analysis showed no difference in overall survival or disease-free interval between the transfused and non-transfused groups. Conclusions: After correction for other prognostic factors, blood transfusion had no prognostic significance in patients with early cervical cancer undergoing radical hysterectomy.Presented at the 50th Annual Cancer Symposium of The Society of Surgical Oncology, Chicago, Illinois, March 20–23, 1997.     

Incidence and range of carboxyhaemoglobin in blood for transfusion

No statistically significant difference was found between the levels of carboxyhaemoglobin detected in samples from 42 blood units and their sample side arms. A cooximeter was used. However, carboxyhaemoglobin in a range of 1.1-6.9% was found in 18 out of a further 100 side arm samples taken randomly from the blood bank.     

等容血液稀释自体输血对肿瘤病人围术期T淋巴细胞亚群、NK细胞影响的比较

目的：探讨异体输血和等容血液稀释自体输血对围术期T淋巴细胞亚群,NK细胞的变化。方法：选择直肠癌,结肠癌格或胃癌根治术病人30例,随机均分为2组。H组术中输异体全血400ml;A组于手术切皮前放血400ml,同时输入等量羟乙基淀粉。术中自体血回输给病人。分别于术前,输血前,术后第1d,第5d抽取静脉血,用流林细胞仪测定T细胞亚群和NK细胞的数量。结果：两组术后第1dCD3^ ,CD4^ ,CD4^ /CD8^ ,NK细胞较术前显著减少（P＜0．05或0．01）,异体输血组较自体输血组减少更明显（P＜0．05）。术后第5d异体输血组CD3^ ,CD4^ ,CD4^ /CD8^ ,NK细胞仍较术前显著减少,自体输血组基本恢复正常。结论：围术期输异体血严重抑制病人免疫,因液稀释自体输血免疫抑制轻微,且术后免疫功能很快恢复。     

Long-term outcomes of an integrated transfusion reduction initiative in patients undergoing resection for colorectal cancer

Background

Perioperative blood transfusion in patients with colorectal cancer has been associated with increased cost, morbidity, mortality, and decreased survival. Five years ago, a transfusion reduction initiative (TRI) was implemented. We sought to evaluate the 5-year effectiveness and patient outcomes before and after the TRI.

Methods

Patients who underwent colorectal resection for adenocarcinomas before (January 2006 to October 2009) and after the TRI (November 2009 to December 2013) were reviewed.

Results

A total of 484 patients were included; 267 and 217 patients were in the pre- and post-TRI groups, respectively. Decreased overall transfusion rates were sustained throughout the entire post-TRI era (17% vs 28%, P = .006). Three-year colorectal cancer disease-free survival rates were similar in the pre- and post-TRI eras at 85.3% (95% confidence interval [CI]: 79.9 to 89.3) and 81.6% (95% CI: 71.9 to 88.2), respectively. Three-year disease-free survival rate was lower in those receiving BTs vs those without BTs at 78.4% (95% CI: 65.7 to 86.8) vs 85.3% (95% CI: 80.4 to 89.1), respectively.

Conclusions

A TRI remains a safe, effective way to reduce blood utilization in colorectal cancer surgery.     

术中库血输注对脊柱手术患者血糖的影响

目的 研究术中库血输注对脊柱手术患者血糖的影响.方法 随机选择32例脊柱侧凸后路矫形术患者作为输血组（A组）,20例脊柱侧凸前路松解术患者作为非输血组（B组）.输血组均确定在手术开始2 h后开始输血.记录麻醉诱导后（Ta）、手术开始即刻（T0）、手术1 h（T1）、2 h（T2）、3 h（T3）、4 h（T4）、5 h（T5）7个时间点静脉血血糖值.所输库血为枸橼酸磷酸盐葡萄糖（CPD）-红细胞悬液,存储时间为（10.0±5.6）d,血糖值为（19.8±5.3）mmol/L.结果 （1）Ta至T2期间,两组患者血糖的变化呈逐渐上升趋势,T2至T5期间,B组血糖趋于平稳,A组的血糖进一步升高.（2）A组患者中,有21例（65.6%）输血后即刻血糖值超过了6.4 mmol/L,7例（21.9%）输血后即刻血糖值超过了7.8 mmol/L.结论 术中输注库血可以引起患者血糖的升高.     

大通道经皮肾镜取石患者围手术期出血原因及输血治疗的探讨

目的探讨经皮肾镜取石术患者围术期出血的原因及其输血治疗的策略。方法回顾性分析2008年6月至2010年6月在我院行大通道经皮肾镜取石术的202例患者临床资料,对各种可能影响出血量的因素进行多因素回归分析,以寻求影响手术出血量的主要因素,并统计各类成分血输注量,评价输血效果。结果202例患者平均出血量为150±30．5ml,平均血红蛋白降低为1．0±0．62g/dL,其中有9例忠者进行输血治疗,输血率为4．5％。输血以红细胞悬液为主。多因素回归分析发现孤立肾、高血压、术前尿路感染、结石面积、肾实质厚度、肾积水程度、通道数量和手术时间对出血量有明显影响。结论孤立肾、高血压、术前尿路感染、结石面积大、肾实质厚、肾积水轻、多通道和手术时间长会增加经皮肾镜取石术出血,输血对其治疗有重要意义。