Clinical Guidelines for Blood Conservation During Cardiac Procedures Developed
心脏手术中的血液保护临床指南产生
Newswise — A team of medical experts led by a Virginia Commonwealth University anesthesiologist and a thoracic surgeon from the University of Kentucky has established a set of clinical guidelines to help physicians decrease the need for blood transfusions in high-risk patients during cardiac operations.
Newswise—由弗吉尼亚联邦大学的麻醉医师和肯塔基大学的胸心外科医师带领的医学专家小组最近建立了一套旨在减少高危患者在心脏手术中的输血需求的临床指南。
The team, led by Bruce Spiess, M.D., professor in the Department of Anesthesiology at the VCU School of Medicine and director of VCURES Shock Research Center, and Victor A. Ferraris, M.D., chief of the Division of Cardiothoracic Surgery at the University of Kentucky’s Albert B. Chandler Hospital, developed the guidelines, “Perioperative Blood Transfusion and Blood Conservation in Cardiac Surgery.” It appears as a standalone supplement to the May 2007 issue of the The Annals of Thoracic Surgery.
由弗吉尼亚大学医学院麻醉学分部的教授兼该校休克复苏研究中心主任Bruce Spiess博士和肯塔基大学Albert B.Chandler医院胸心外科主任Victor A.Ferraris博士领导的小组发表了指南—“心脏外科围手术期输血和血液保护”。这象是个2007年《胸心外科年鉴》的独立增补。
“Blood must be viewed as a scarce resource that carries risks and benefits,” said Spiess. “This is a huge event for medicine. If these guidelines are adopted by a majority of cardiovascular centers in the world, we can decrease the amount of blood transfusions, blood usage and cost and blood shortages would be less frequent and not occur to such a degree.
“血液应当是一种会同时带来风险和益处的稀缺资源，”Spiess说，“这是医学界的大事。如果这些指南被世界上大多数的心血管中心采用，我们就可以减少输血量、血液的使用和支出，血液短缺的现象会减少，不会再如此频繁的发生。”
“There is very strong evidence that patients who receive more blood have more post operative infection, have more renal failure and have more lung dysfunction,” he said.
“有明确的事实证明患者术中输血越多，术后感染的几率就越大，肾功能衰竭和肺功能不全的发生率也越大，”他说。
According to the report, about 15 to 20 percent of patients undergoing cardiac procedures consume more than 80 percent of the blood products transfused at operation.
据报道称，约15%至20%的心脏手术患者消耗了80%的手术用血。
Ferraris agreed with the great significance of the guidelines.“The blood conservation practice guidelines generated under the auspices of the Society of Thoracic Surgeons represents a landmark undertaking,” he said. “This work should serve as a template for individual cardiothoracic surgeons and for institutions as they manage valuable and scarce blood component resources.”
Ferraris肯定了指南的重大意义。“由胸外科医师赞助产生的血液保护操作指南是一项里程碑式的事业，”他说。“这些工作应该成为每个胸心外科医师的典范，也应成为各机构处理稀有而珍贵的成分血资源的指导。”
In the analysis, the committees from the Society of Thoracic Surgeons, chaired by Ferraris, and the Society of Cardiovascular Anesthesiologists’ Task Force on Blood Transfusion, chaired by Spiess, collaborated over a period of four years in determining the evidence-based series of recommendation for practice.
由Ferraris任主席的胸外科医师协会委员会和由Spiess任主席的心血管麻醉医师输血推进协会，在这次分析中经过4年的合作，确定了一系列的循证操作建议。
They reviewed all available published evidence related to blood conservation during cardiac operations and identified preoperative and perioperative interventions that are likely to reduce bleeding and postoperative blood transfusion.
他们回顾了所有发表的和心脏手术血液保护有关的证据，明确了能减少出血和术后输血的围手术期干预。
The guidelines suggest that institution-specific protocols should screen for high-risk patients, as blood conservation interventions are likely to be most productive for this high-risk subset.
指南建议，针对机构的操作规程应当筛选高危患者，应为高危部分的患者是血液保护干预最有效果的。
Some evidence-based blood conservation techniques include drugs that increase preoperative blood volume or decrease postoperative bleeding; devices that conserve blood; and interventions that protect the patient’s own blood from the stress of operation.
一些循证血液保护技术包括提高术前血容量或减少术后出血的药物；保护血液的装置；以及保护患者自己的血液免受手术应激的干预。
“We already do most or all of these things here at the VCU Medical Center and have led the nation in implementing an entire program,” said Spiess. “We have not only been successful in cardiac surgery but also now have a full program for the whole hospital.”
“我们在弗吉尼亚联邦大学医学中心以及全部或大部分做到了，并已经带领全国实施整个计划，”Spiess说。“我们不但在心脏手术中获得了成功，而且还对整个医院有一个完整的计划。”
The guidelines are available online at >
