Author/Editor		Borovšak, Zvonko
Title		Vpliv anemije v perioperativnem obdobju na izid kirurškega zdravljenja
Translated title		Influence of anaemia in perioperative period on the outcome of the surgical procedures
Type		članek
Source		In: Optimalno zdravljenje anemije v perioperativnem obdobju in varnost transfuzijskega zdravljenja: zbornik strokovnih prispevkov 8. podiplomskega seminarja Zdravljenje s krvjo, Portorož, 23.-24. november 2007 Ljubljana : Zavod Republike Slovenije za transfuzijsko medicino
Publication year		2007
Volume		str. 31-36
Language		slv
Abstract		Več kot pri tretjini bolnikov je prisotna anemija pred operacijo. Pooperativna anemija se zaradi motenega odgovora eritropetina lahko pojavi pri 90 % bolnikov. Anemija pri kirurških bolnikih je povezana s povečano pooperativno obolevnostjo, umrljivostjo in zmanjšano kakovostjo življenja. Zdravljenje anemije pred operacijo zmanjša potrebo po transfuziji koncentriranih eritrocitov (KE) med operacijo in po njej, izboljša bolnikov izid zdravljenja in kakovost življenja. Anemijo je potrebno oceniti klinično in ne samo na osnovi laboratorijskih vrednosti. Zdravljenje anemije pred operacijo vključuje transfuzijo krvi in alternativne oblike transfuzije. Transfuziji homologne krvi se je potrebno izogniti kadarkoli je to mogoče. Cilj je izboljšati pooperativni izid, ker se izključi s transfuzijo povezano tveganje reakcij na kri, prenos bolezni in imunomodulacija. Osnovni cilj zdravljenja anemije je zmanjšati tveganje zapletov, povezanih z neustrezno oksigenacijo ne glede na vrednost hemoglobina. Zdravljenje z rekombinantnim humanim eritropoetinom se je izkazalo kot zelo uspešno pri zdravljenju preoperativne anemije pri načrtovanih operativnih posegih, medtem ko pri zdravljenju anemije pri kritično bolnih z rekombinantnim humanim eritropoetinom ni ugotovljena zmanjšana umrljivost in obolevnost.One-third to one-half of surgical patients may be anemic preoperatively because of conditions for which they require surgery. Postoperative anemia may occur in up to 90 per cent of patients, probably due to a blunted erythropoietic response. In surgical patients, anemia has been linked to increased pooperative morbidity and mortality and decreased quality of life. Treatment of perioperative anemia has been shown to decrease the need for transfusion and improve patient outcome and quality of life. Anemia should be viewed as a significant clinical condition rather than simply an abnormal laboratory value. Morbidity and mortality after surgery are significantly associated with the presence of preoperative anemia. The best way to avoid the bad prognosis regarding anemia is to treat anemia preoperatively. These includes allogeneic blood transfusion, the use of single transfusion alternatives or combinations of the alternatives. Transfusion of allogeneic blood should be avoided whenever is possible, not only because it has not been proven to improve postoperative outcomes but because the transfusion risk include reactions, disease transmission and immunomodulation. The principal conclusion of the task force are that blood cell transfusions should not be dictated by a single hemoglobin trigger but instead should be based on the patient's risks of developing complications of inadequate oxygenation whatever the values of hemoglobin are. Pharmacological management of anemia with recombinant human erythropoietin has been well studied in many different types of surgery and helps to avoid or reduce the need for allogeneic blood transfusion. In intensive care unit the managemnt of anemia with recombinant human erythropoietin in critically ill patients should be restricted until randomized and independent studies will be done.
Descriptors		Blood Transfusion Krvna transfuzija Preoperative Care Predoperativna nega Anemia Anemija Surgical Procedures, Operative Kirurški postopki, operativni Treatment Outcome Izid zdravljenja