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BACKGROUND@#Red-cell transfusion is critical for surgery during the peri-operative period; however, the transfusion threshold remains controversial mainly owing to the diversity among patients. The patient's medical status should be evaluated before making a transfusion decision. Herein, we developed an individualized transfusion strategy using the West-China-Liu's Score based on the physiology of oxygen delivery/consumption balance and designed an open-label, multicenter, randomized clinical trial to verify whether it reduced red cell requirement as compared with that associated with restrictive and liberal strategies safely and effectively, providing valid evidence for peri-operative transfusion.@*METHODS@#Patients aged >14 years undergoing elective non-cardiac surgery with estimated blood loss > 1000 mL or 20% blood volume and hemoglobin concentration <10 g/dL were randomly assigned to an individualized strategy, a restrictive strategy following China's guideline or a liberal strategy with a transfusion threshold of hemoglobin concentration <9.5 g/dL. We evaluated two primary outcomes: the proportion of patients who received red blood cells (superiority test) and a composite of in-hospital complications and all-cause mortality by day 30 (non-inferiority test).@*RESULTS@#We enrolled 1182 patients: 379, 419, and 384 received individualized, restrictive, and liberal strategies, respectively. Approximately 30.6% (116/379) of patients in the individualized strategy received a red-cell transfusion, less than 62.5% (262/419) in the restrictive strategy (absolute risk difference, 31.92%; 97.5% confidence interval [CI]: 24.42-39.42%; odds ratio, 3.78%; 97.5% CI: 2.70-5.30%; P <0.001), and 89.8% (345/384) in the liberal strategy (absolute risk difference, 59.24%; 97.5% CI: 52.91-65.57%; odds ratio, 20.06; 97.5% CI: 12.74-31.57; P <0.001). No statistically significant differences were found in the composite of in-hospital complications and mortality by day 30 among the three strategies.@*CONCLUSION@#The individualized red-cell transfusion strategy using the West-China-Liu's Score reduced red-cell transfusion without increasing in-hospital complications and mortality by day 30 when compared with restrictive and liberal strategies in elective non-cardiac surgeries.@*TRIAL REGISTRATION@#ClinicalTrials.gov, NCT01597232.
Subject(s)
Humans , Adult , Postoperative Complications , Erythrocyte Transfusion/adverse effects , Blood Transfusion , Hospitals , Hemoglobins/analysisABSTRACT
Objective To discuss clinical application,value and effect of tracheal stent in surgical operation for tracheostenosis caused by thyroid tumor.Methods Clinical data of 6 patients with tracheal stenosis and dyspnea caused by thyroid tumor invasiveness or tracheal compression from Oct.2015 to Sep.2016 were retrospectively analyzed.Of the 6 patients,1 case had nodular goiter and 5 cases had differentiated thyroid carcinoma(DTC).Results All patients had dyspnea caused by thyroid tumor invasiveness or tracheal compression.Dyspnea relieved dramatically after tracheal stent was implantated under local anesthesia.Thyroidectomy was given later,with intraoperative tracheal intubation as well as anesthesia,and the surgery finally succeeded.One case with benign multinodular goiter received complete resection and 5 cases with DTC invading the trachea received complete resection of thyroid and neck lymph node dissection,followed by end-to-end anastomosis of invaded trachea sleeve resection.All patients got stage Ⅰ healing in surgical wound.Five cases received radioactive 131I treatment as well as TSH suppression therapy after DTC surgery.All patients were alive and disease-free after a follow-up of 4 to 15 months.Conclusions For patients with tracheostenosis caused by thyroid tumor invasiveness or tracheal compression,operation under cardiopulmonary bypass is necessary if tracheal intubation is difficult.For hospitals without cardiopulmonary bypass,tracheal stent implantation can effectively relieve dyspnea symptom and reduce risk of tracheal intubation under anesthesia,which provides possibility for surgical treatment.
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Objective To evaluate the effect of sevoflurane preconditioning on the expression of heat shock protein 70 (HSP70) during renal ischemia-reperfusion in rats.Methods Twenty-four pathogen-free healthy adult male Sprague-Dawley rats,weighing 250-300 g,aged 2-3 months,were divided into 3 groups (n=8 each) using a random number table:sham operation group (group S),renal I/R group (group I/R) and sevoflurane preconditioning group (group SP).The animals were anesthetized with 2％ pentobarbital sodium 50 mg/kg.After the right kidney was removed,the left renal artery was clamped for 45 min followed by 2 h reperfusion to establish the model of renal I/R injury.In group SP,2.2％ sevoflurane was inhaled for 1 h followed by 10-min washout before the model was established.The animals were sacrificed at the end of rcpcrfusion,and kidneys were then removed for determination of the expression of HSP70 (by immunohistochemistry) and malondialdehyde (MDA) content in renal tissues (by thiobarbituric acid colorimetric method).Results Compared with group S,the expression of HSP70 in renal tissues was significantly up-regulated,and the MDA content in renal tissues was increased in t/R and SP groups (P＜0.05).Compared with group I/R,the expression of HSP70 in renal tissues was significantly up-regulated,and the MDA content in renal tissues was decreased in group SP (P＜0.05).Conclusion The mechanism by which sevoflurane preconditioning reduces renal I/R injury is related to up-regulation of HSP70 expression in rats.
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Objective To investigate the effects of sevoflurane preconditioning on renal ischemia-reperfusion(I/R)injury in rats.Methods Twenty-four adult male SD rats weighing 250-300 g were randomly divided into 3 groups(n=8 each):sham operation group (group S);I/R group; sevoflurane preconditioning group (group SP). After the rats underwent right nephrectomy, renal I/R was produced by occlusion of left renal artery for 45 min followed by reperfusion in I/R and SP groups.In group SP, the rats inhaled 2.2% sevoflurane for 1 h, then the inhalation was stopped and renal ischemia was performed 10 min later. Venous blood samples were collected at 2 h of reperfusion to determine the concentrations of serum creatinine(Cr), urea nitrogen (BUN), cystatin C (Cys C) . The renal tissues were obtained for microscopic examination, and Paller's score was recorded. Results Compared with group S, there was no significant difference in the serum Cr and BUN concentrations (P＞0.05), while the serum Cys C concentration and Paller's score for acute renal tubular injury were significantly increased in group I/R(P＜0.05). The serum Cys C concentration and Paller's score were significantly lower in group SP than in group I/R(P＜0.05).I/R-induced renal injury was significantly reduced in group SP compared with group I/R. Conclusion Preconditioning with sevoflurane can provide significant protection against renal I/R injury.