手术患者减少出血和输血及其成分的原则-外科方面

IF 0.6 Q4 SURGERY Polish Journal of Surgery Pub Date : 2023-09-20 DOI:10.5604/01.3001.0053.8966
Tomasz Banasiewicz, Waldemar Machała, Maciej Borejsza Wysocki, Maciej Lesiak, Sebastian Krych, Małgorzata Lange, Piotr Hogendorf, Adam Durczyński, Jarosław Cwaliński, Tomasz Bartkowiak, Adam Dziki, Wojciech Kielan, Stanisław Kłęk, Łukasz Krokowicz, Krzysztof Kusza, Piotr Myśliwiec, Michał Pędziwiatr, Piotr Richter, Jacek Sobocki, Marek Szczepkowski, Wiesław Tarnowski, Wojciech Zegarski, Michał Zembala, Krzysztof Zieniewicz, Grzegorz Wallner
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引用次数: 0

摘要

外科围手术期治疗的目标之一是减少术中出血,但术中出血增加了围手术期手术次数、死亡率和治疗费用,也增加了输血及其成分的风险。尽量减少失血量(主要是在手术期间)以及输血及其成分的需要(广泛理解为围手术期)应该是接受手术的患者的标准治疗。采用此法时,应采取以下措施:1)术前:尽早识别危险人群,发现并治疗贫血,应用康复治疗,调整抗凝治疗,部分患者考虑自行献血,部分病例考虑使用促红细胞生成素制剂;2)围手术期:以正常体温、正常血容量、正常血糖为目标,采用减少出血的手术方法,如微创手术、高能凝血、局部止血、预防手术部位感染,如发生出血,适当输注血液及其成分;3)术后:监测患者情况,主要是检查出血情况,必要时快速再手术,补充(口服)营养微量元素(铁)和维生素,更新其一般情况。所有这些活动,在麻醉医师的全面和外科合作下,应减少失血和血液及其成分的输血。
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Principles of minimize bleeding and the transfusion of blood and its components in operated patients – surgical aspects
One of the target of perioperative tratment in surgery is decreasing intraoperative bleeding, which increases the number of perioperative procedures, mortality and treatment costs, and also causes the risk of transfusion of blood and its components. Trying to minimize the blood loss(mainly during the operation) as well as the need to transfuse blood and its components (broadly understood perioperative period) should be standard treatment for a patient undergoing a procedure. In the case of this method, the following steps should be taken: 1) in the preoperative period: identyfication of risk groups as quickly as possible, detecting and treating anemia, applying prehabilitation, modyfying anticoagulant treatment, considering donating one's own blood in some patients and in selected cases erythropoietin preparations; 2) in the perioperative period: aim for normothermia, normovolemia and normoglycemia, use of surgical methods that reduce bleeding, such as minimally invasive surgery, high-energy coagulation, local hemostatics, prevention of surgical site infection, proper transfusion of blood and its components if it occurs; 3) in the postoperative period: monitor the condition of patients, primarily for the detection of bleeding, rapid reoperation if required, suplementation (oral administration preferred) nutrition with microelements (iron) and vitamins, updating its general condition. All these activities, comprehensively and in surgical cooperation with the anesthesiologist, should reduce the blood loss and transfusion of blood and its components.
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