Clinical Research On The Safety And Effectivity Of Transfusion Plan Guided By Peri-operative Transfusion Trigger Score

Objective: The peri-operative Hb level of many patients lies between6～10g/dL,however there exists no physiologic transfusion guidelines for operative or traumaticpatients whose peri-operative Hb just lies between such level around the world. We came up with “peri-operative transfusion trigger score”(POTTS) plan and designed this study, in order to evaluate the safety and effectivity of transfusion plan guided by POTTS in patients who’s hemoglobin level ranged between6～10g/dL.Methods: This study was one randomized, single blind, open and controlled clinical research. Patients undergoing selective operations at the affiliated hospital of Zunyi Medical College from March2012to July2013were chosen, all patients neededto be screened firstly, those who had passed the above experimental screening while peri-operative Hb less than10g/dL could be formally included in this study. Exclusive criteria: emergency operations; ASA-V or VI; clearly diagnosed with severe hematological system diseases; clearly diagnosed with oxygen carrying capacity defects of Hb; those who must undergo hypervolemic hemodilution; tumors with distantmetastasis; patients who can’t coordinate with experiment requirements for whateverreasons; patients who have taken part in other clinical studies within3months before this study; investigators consider not suitable. All patients were randomized into3groups by computer software:①P OTTSguided group: patients in this group received transfusion administration strictly under the guidance of POTTS plan;②10ggroup: patients in this group must be transfused enough for keeping their peri-operative Hb level no less than10g/dL;③7-10g guideline group: while those in this group received transfusion according to doctors’ experiences. We then compared:①peri-operative transfusion percentage and the amount of RBC transfused;②incidence ofsevere complications and mortality;③postoperative drainage amount and drainage t ube placement time;④operative incision healing situations;⑤total hospital stays;⑥transfusion related fees and total hospitalization expenses;⑦postoperative life quality.Results:402patients had passed experimental screening successfully, and60of which had actually been included in this study formally, POTTS guided group accounted for22cases,10g group had17cases,7-10g guideline group had15cases ofthem. One patient withdrew from the10g group for aggravation of primary diseases and was transferred to ICU for further treatment, another patient was excluded for failure in collection24h Hb level before leaving, thus only15patients in this group had truly finished this study. Baseline analysis of three groups had no statistical difference（P>0.05）, thus they had comparability.1.The transfusion proportion ofPOTTS guided group,10g group and7-10g group were18.0%,100%,67.0%respectively, the results had a statistical significance(P<0.05）.2.The per capita transfusion amount of three groups were0.6±1.1U,3.8±1.7U,1.9±1.8U respectively, the results showed a remarkable statistical significance(P<0.01）.3.The incidences of severe complications and mortality:①2cases of fever happened in POTTS group,2cases of fever and1case of transfusion related allergic reactions happened in10g group,1case of fever and1case of incision exudation happened in7-10g group; nomortality appeared in any of the three groups;②there were no significant difference of complications between three groups （P>0.05）.4. ICU occupancy rate and ICU time: there were no patients who had been transferred to ICU for further treatment in3test groups.5. Postoperative Hb recovery situations: the surgery ended Hb level,24h after surgery and leaving hospital Hb level of10g group and7-10g gr oup were higher than that of POTTS group, there were statistical significances(P>0.05).6. Postoperative drainage amount and drainage tube extraction time comparison:the2h,6h,12h,18h,24h,2d and3d after surgery drainage amount comparison showed no statistical significance(P>0.05); drainage tube extraction time had statisticalsignificance(P<0.05）.7.Operative incision healing situation comparison: all subjects had first class healing except one second class healing in7-10g group, there were no statistical significance(P>0.05), neither did suture removal time had any statistical significance(P>0.05).8. Hospital stays comparison: the lengths of hospital stay forthe above three groups were20.0±0.9d,25.7±10.4d,23.5±9.8d respectively (P>0.05).9. Transfusion fees and hospital stay expenses comparison: the transfusion related fees of POTTS group was much less than that of the other2groups(P<0.05), however there showed no statistical significance regarding hospital stay fees(P>0.05).10. Postoperative life quality comparison: no any new severe complications or mortality happened after follow-up visit for one whole year.Conclusion:1.POTTS guided transfusion plan can effectively reduce peri-operative transfusion proportion and amount, attaining the goal to save blood while reducing iatrogenic waste.2. POTTS guided transfusion plan will not increase the postoperative complication incidence or mortality of experimenters, but can help to avoid transfusion related risks and thus guarantee patients’ safety.3. POTTS guided transfusionplan can cut down transfusion fees, alleviating patients’ economic burdens.