- 作者：Timothy L. Frankel ; Mary Fischer ; Florence Grant ; Jennifer Krone ; Michael I. D'Angelica ; Ronald P. DeMatteo ; William R. Jarnagin ; Mithat G?nen
- 关键词：ANH ; acute normovolemic hemodilution ; EBL ; estimated blood loss ; FFP ; fresh frozen plasma ; INR ; international normalized ratio ; PBRC ; packed red blood cell
- 刊名：Journal of the American College of Surgeons
- 出版年：2013
- 出版时间：August, 2013
- 年：2013
- 卷：217
- 期：2
- 页码：210-220
- 全文大小：326 K
Background
Acute normovolemic hemodilution (ANH) decreases transfusion rates but adds to the complexity of anesthetic management during hepatectomy. A randomized controlled trial was conducted to determine if selecting patients for ANH using a transfusion nomogram improves management and resource use compared with selection using extent of resection.Study Design
One hundred fourteen patients undergoing partial hepatectomy were randomized to a clinical arm (ANH used for resection of ¡Ý3 liver segments) or a nomogram arm (ANH used for predicted probability of transfusion ¡Ý50 % based on a previously validated nomogram). The primary end point was appropriate management, defined as avoidance of ANH in patients at low risk or use of ANH in patients at high risk for allogeneic red blood cell transfusions.
Results
Between September 2009 and May 2011, 58 patients were randomized to the clinical arm and 56 to the nomogram arm. Demographics, diagnoses, extent of resection, blood loss, and incidence and grade of complications did not differ between the 2 groups. There were no differences in perioperative transfusions or laboratory values. Nomogram-based allocation did not change appropriate management overall (80 % vs 76 % in the clinical arm; p?=?0.65), but did result in comparable perioperative outcomes and a trend toward decreased ANH use (30 % vs 47 % ; p?= 0.09), particularly in low blood loss (estimated blood loss ¡Ü400?mL) cases (12 % vs 25 % ; p?= 0.04).
Conclusions
Although allocation of intraoperative management using a transfusion nomogram did not improve appropriate management overall, it more effectively identified low blood loss cases and reduced ANH use in patients least likely to benefit.