The Clinical Study On The Application Of Perioperative Transfusion Trigger Score (POTTS)

Objective:To explore the clinical effect of perioperative transfusion Trigger score（POTTS）in guiding red blood cell transfusion.Methods:The study was designed as a prospective randomized controlled clinical trial involving patients who underwent surgery at the Third Affiliated Hospital of Guangxi Medical University between October 2018 and September2020.Inclusion criteria:patients aged≥14 years,living at an altitude of less than 2500 m,having a hemoglobin concentration of less than 100g/L,or having a hemoglobin concentration of less than 100g/L after the transfusion of all collected autologous blood were enrolled in elective or emergency surgery.Exclusion criteria:ASA class V or VI,clinical diagnosis of severe blood system disease,clinical diagnosis ability of oxygen-carrying hemoglobin,patients must be high capacitive hemodilution,cardiac surgery patients,need to vascular anastomosis microscopic surgery,for any reason to cooperate with research,3months to participate in other clinical trials or taking other drugs.Patients with perioperative hemoglobin concentration between 60 and100g/L were randomly divided into trial group（POTTS group）and control group.Hemoglobin thresholds were initiated in the POTTS group based on transfusion indication score values,and in the control group by clinicians based on patient condition and clinical experience.Main Outcome Measures:Inoperative allogenous red blood cell infusion ratio and infusion volume,postoperative hemoglobin concentration,mortality and incidence of postoperative serious complications,postoperative blood gas results（lactic acid,p H value,oxygenation index,Pa CO₂,Pa O₂,residual alkali,oxygenation index）.Secondary Outcome Indicators:ICU occupancy rate,ICU hospitalization days,total hospitalization days,postoperative hospitalization days,surgical incision healing,coagulation function,vital signs of subjects at each time point（blood pressure,heart rate,central body temperature）,and recovery of patients 1 month after discharge,etc.Results:A total of 200 patients were enrolled,including 104 in the POTTS group and 96 in the control group.Both groups completed the trial.There were no significant differences between the two groups in demographic baseline,complicated basic diseases,surgical department and type,ASA grade,blood loss during operation,autotransfusion cases,preoperative hemoglobin value and other indicators（P>0.05）.Compared with the control group,the proportion of red blood cell transfusion in the evaluation group was（15.38%vs 27.08%,P<0.05）,and the amount of transfusion was less（P<0.05）.There were no statistical differences in postoperative lactic acid,p H,oxygenation index,Pa CO₂,Pa O₂,residual alkali,blood pressure,heart rate and central body temperature between 2 groups（P>0.05）.Mortality,the incidence of serious complications after the two groups,incision healing,and 24 hour after discharge of occupancy and hemoglobin value,the ICU stay days and total hospitalization days,postoperative hospitalization days and total hospitalization expenses,blood coagulation function after operation,1 month after discharge,recovery and other indicators,no statistical difference（P>0.05）.Conclusion:The use of perioperative blood transfusion indicator score to guide perioperative blood transfusion can reduce the use rate and infusion volume of red blood cells,and does not increase the postoperative serious complications and postoperative mortality,and can be safely applied in clinical practice.