在心脏外科手术中实施个性化血液管理计划:前后研究
Constance Bougnoux1, Sacha Rozencwajg2, Jacques Thes1
1Department of Anesthesiology and Critical Care, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Le Plessis-Robinson, France.
Anaesthesia, critical care & pain medicine
|March 6, 2026
概括
在心脏外科手术中实施患者血液管理 (PBM) 计划显著减少了红细胞 (RBC) 输血和成本. 这种PBM策略改善了患者的治疗结果,而不会增加术后并发症.
科学领域:
- 心脏病学 心脏病学
- 麻醉学 麻醉学
- 输血医学 输血医学
背景情况:
- 在心脏手术患者中,手术前的贫血和铁缺乏是普遍存在的.
- 这些情况增加了输血需求,发病率,死亡率和医疗保健费用.
- 将患者血液管理 (PBM) 整合到临床实践中存在挑战.
研究的目的:
- 评估实用性患者血液管理 (PBM) 计划对红细胞 (RBC) 输血率的影响.
- 评估PBM实施后手术后并发症和医疗保健成本的变化.
- 为了确定PBM在选择性式心脏手术中的有效性.
主要方法:
- 采用单一中心,回顾性前后研究设计.
- 该研究包括在PBM实施前和之后接受选择性抽动心脏手术的患者.
- 该PBM协议包括手术前贫血纠正,最小化血液稀释,单单元红细胞输血实践和术后补充铁.
主要成果:
- 在PBM实施后,红细胞输血率从33%降至26% (p=0.02).
- PBM独立地与输血风险降低 (OR0.58;p<0.01) 相关,单个单位输血的比率更高.
- 估计每年节省的成本达到了66223欧元,手术后并发症没有显著增加.
结论:
- 一个务实的PBM程序有效地减少了心脏手术中的红细胞输血.
- 实施PBM带来了显著的医疗成本节省.
- 该PBM计划改善了患者的血液管理,而不会对术后结果产生不利影响.
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