2.本星期三（5.23）晚上11点前交稿
3.格式见置顶的文摘编译格式：
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4.稿酬按医师报标准
5.为保证翻译质量起见，在本版得分超过15分以上的战友方可认领
6.每位战友最多认领2篇,编译群战友可根据自己的专业和精力，最多认领3篇
7.作者统一署名为"丁香"
8.质量第一，切切
9.文中出现的杂志名称用原文，无需翻译
Perioperative Blood Transfusion and Blood Conservation in Cardiac Surgery: The Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists Clinical Practice Guideline
Background: A minority of patients having cardiac procedures (15% to 20%) consume more than 80% of the blood products transfused at operation. Blood must be viewed as a scarce resource that carries risks and benefits. A careful review of available evidence can provide guidelines to allocate this valuable resource and improve patient outcomes.
Methods: We reviewed all available published evidence related to blood conservation during cardiac operations, including randomized controlled trials, published observational information, and case reports. Conventional methods identified the level of evidence available for each of the blood conservation interventions. After considering the level of evidence, recommendations were made regarding each intervention using the American Heart Association/American College of Cardiology classification scheme.
Results: Review of published reports identified a high-risk profile associated with increased postoperative blood transfusion. Six variables stand out as important indicators of risk: (1) advanced age, (2) low preoperative red blood cell volume (preoperative anemia or small body size), (3) preoperative antiplatelet or antithrombotic drugs, (4) reoperative or complex procedures, (5) emergency operations, and noncardiac patient comorbidities. Careful review revealed preoperative and perioperative interventions that are likely to reduce bleeding and postoperative blood transfusion. Preoperative interventions that are likely to reduce blood transfusion include identification of high-risk patients who should receive all available preoperative and perioperative blood conservation interventions and limitation of antithrombotic drugs. Perioperative blood conservation interventions include use of antifibrinolytic drugs, selective use of off-pump coronary artery bypass graft surgery, routine use of a cell-saving device, and implementation of appropriate transfusion indications. An important intervention is application of a multimodality blood conservation program that is institution based, accepted by all health care providers, and that involves well thought out transfusion algorithms to guide transfusion decisions.
Conclusions: Based on available evidence, institution-specific protocols should screen for high-risk patients, as blood conservation interventions are likely to be most productive for this high-risk subset. Available evidence-based blood conservation techniques include (1) drugs that increase preoperative blood volume (eg, erythropoietin) or decrease postoperative bleeding (eg, antifibrinolytics), (2) devices that conserve blood (eg, intraoperative blood salvage and blood sparing interventions), (3) interventions that protect the patient’s own blood from the stress of operation (eg, autologous predonation and normovolemic hemodilution), (4) consensus, institution-specific blood transfusion algorithms supplemented with point-of-care testing, and most importantly, (5) a multimodality approach to blood conservation combining all of the above.
本人认领此文. 如在24小时内未能提交译文, 其他战友自由认领.
Perioperative Blood Transfusion and Blood Conservation in Cardiac Surgery: The Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists Clinical Practice Guideline
心脏手术中围术期输血及血液保护：胸外科医师协会和心血管麻醉医师协会临床实践指南
Background: A minority of patients having cardiac procedures (15% to 20%) consume more than 80% of the blood products transfused at operation. Blood must be viewed as a scarce resource that carries risks and benefits. A careful review of available evidence can provide guidelines to allocate this valuable resource and improve patient outcomes.
Methods: We reviewed all available published evidence related to blood conservation during cardiac operations, including randomized controlled trials, published observational information, and case reports. Conventional methods identified the level of evidence available for each of the blood conservation interventions. After considering the level of evidence, recommendations were made regarding each intervention using the American Heart Association/American College of Cardiology classification scheme.
背景：进行心脏手术的少数病人（15～20%）术中输血时消耗了超过80%的血液制品。因此我们必须把血液看作一种同时具有风险和利益的稀缺资源。仔细审视现有证据能为分配这一宝贵资源及改善病人预后提供指导。
方法：我们回顾了已经发表的所有与心脏手术过程中血液保护有关的现成资料，包括随机对照实验，公开观测资料和案例报告。并应用常规方法辨识每种血液保护干预方法的可信度。最后考虑各可信度后，采用美国心脏学会/美国心脏学院分类法对每一种干预方法给出了建议。
Results: Review of published reports identified a high-risk profile associated with increased postoperative blood transfusion. Six variables stand out as important indicators of risk: (1) advanced age, (2) low preoperative red blood cell volume (preoperative anemia or small body size), (3) preoperative antiplatelet or antithrombotic drugs, (4) reoperative or complex procedures, (5) emergency operations, and noncardiac patient comorbidities. Careful review revealed preoperative and perioperative interventions that are likely to reduce bleeding and postoperative blood transfusion. Preoperative interventions that are likely to reduce blood transfusion include identification of high-risk patients who should receive all available preoperative and perioperative blood conservation interventions and limitation of antithrombotic drugs. Perioperative blood conservation interventions include use of antifibrinolytic drugs, selective use of off-pump coronary artery bypass graft surgery, routine use of a cell-saving device, and implementation of appropriate transfusion indications. An important intervention is application of a multimodality blood conservation program that is institution based, accepted by all health care providers, and that involves well thought out transfusion algorithms to guide transfusion decisions.
结果：审查发布的报告确定了一个与术后输血增加有关的高风险概要。它突出了作为重要风险指标的六个参量：（1）老年，（2）术前低血红细胞比容（术前贫血或小体型贫血），（3）术前应用抗血小板或抗血栓形成药，（4）再手术或复杂手术，（5）紧急手术，（6）非心血管病人的共病。仔细审查发现术前和围术期干预可能减少出血和术后输血。包括识别高危病人在内的术前干预可能减少输血，这些病人应该采用所有可用的术前和围术期血液保护干预措施并抗限制抗血栓药的应用。围术期血液保护干预措施包括应用抗纤溶药，非体循环冠状动脉搭桥手术的选择性应用，应用常规的细胞挽救设备，并采用恰当的输血指标。一个重要的干预是应用多重血液保护措施，该措施基于医疗机构并被所有医护人员广泛接受，它以深思熟虑的输血方法来指导输血。
Conclusions: Based on available evidence, institution-specific protocols should screen for high-risk patients, as blood conservation interventions are likely to be most productive for this high-risk subset. Available evidence-based blood conservation techniques include (1) drugs that increase preoperative blood volume (eg, erythropoietin) or decrease postoperative bleeding (eg, antifibrinolytics), (2) devices that conserve blood (eg, intraoperative blood salvage and blood sparing interventions), (3) interventions that protect the patient’s own blood from the stress of operation (eg, autologous predonation and normovolemic hemodilution), (4) consensus, institution-specific blood transfusion algorithms supplemented with point-of-care testing, and most importantly, (5) a multimodality approach to blood conservation combining all of the above.
结论：根据现有的证据，医疗机构特有的方案应包括对高危病人进行筛选，因为血液保护干预措施对该群体可能是最富有成效的。现有的有关血液保护的技术包括：（1）增加术前血容量的药物（如红细胞生成素）或减少术后出血的药物（如抗纤溶药），（2）保全血液的设备（如术中血液回收利用和血液节约措施），（3）保护病人自身血液不受术中压力影响的措施（如自体输血和等容性血液稀释），（4）达成医疗机构特有的输血算法的共识,并附以点式医疗测试，(5）最重要的是上述血液保护措施的综合应用。
编译：（866）
据胸外科医师协会和心血管麻醉医师协会临床实践指南显示，血液已成为一种宝贵资源。加强术前和围术期干预，减少出血和术后输血，是节约血液的重要途径。
事实证明，进行心脏手术的少数病人（15～20%）术中输血时消耗了超过80%的血液制品。因此我们必须把血液看作一种同时具有风险和利益的稀缺资源。仔细审视现有证据能为分配这一宝贵资源及改善病人预后提供指导。
我们回顾了已经发表的所有与心脏手术过程中血液保护有关的现成资料，包括随机对照实验，公开观测资料和案例报告。并应用常规方法辨识每种血液保护干预方法的可信度。在考虑各可信度后，采用美国心脏学会/美国心脏学院分类法对每一种干预方法给出了建议。
通过仔细审查发布的报告，我们确定了一个与术后输血增加有关的高风险概要。它突出了作为重要风险指标的六个参量：（1）老年，（2）术前低血红细胞比容（术前贫血或小体型贫血），（3）术前应用抗血小板或抗血栓形成药，（4）再手术或复杂手术，（5）紧急手术，（6）非心血管病人的共痛。同时发现术前和围术期干预可能减少出血和术后输血，包括识别高危病人在内的术前干预可能减少输血，这些病人应该采用所有可用的术前和围术期血液保护干预措施并抗限制抗血栓药的应用。围术期血液保护干预包括应用抗纤溶药，选择应用非体外循环的冠状动脉搭桥手术，应用常规的细胞挽救设备，并执行恰当的输血指标。一个重要的干预是应用多重血液保护措施，该措施基于医疗机构并被所有医护人员广泛接受，它以深思熟虑的输血方法来指导输血。
根据现有的证据，医疗机构特有的方案应包括对高危病人进行筛选，因为血液保护干预措施对该群体可能是最富有成效的。现有的有关血液保护技术包括：（1）增加术前血液量的药物（如红细胞生成素）或减少术后出血的药物（如抗纤溶药），（2）保存血液的设备（如术中血液回收利用和血液节约措施），（3）保护病人自身血液不受术中压力影响的措施（如自体输血和等容性血液稀释），（4）达成医疗机构特有的输血算法的共识,并附以点式医疗测试，（5）最重要的是上述血液保护措施的综合应用。（丁香）
个人观点，仅供参考：
Cardiac Surgery
心血管手术
心脏手术
The Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists
胸外科医师学会和心血管麻醉医师协会
胸外科医师协会和心血管麻醉医师协会
A minority of patients having cardiac procedures (15% to 20%) consume more than 80% of the blood products transfused at operation.
进行心脏手术的少数病人（15～20%）在手术时输血消耗了超过80%的血液制品。
进行心脏手术的少数病人（15－20%）术中输血时消耗了超过80%的血液制品。
Blood must be viewed as a scarce resource that carries risks and benefits.
血液必须被视为一种具有风险和利益的稀缺资源。
我们必须把血液看作一种同时带来风险和益处的稀缺资源。
provide guidelines
提供指引
提供指导
reviewed all available published evidence related to blood conservation during cardiac operations
检查了所有在当前心脏手术中与血液保护有关的公开证据
回顾了所有与心脏手术过程中的血液保护有关的已经发表的现成资料
classification scheme
分类主题
分类法
谢谢！希望以后多指正！