恶性肿瘤患者术中自体血回输的临床实践指南  

Clinical practice guidelines for intraoperative cell salvage in patients with malignant tumors

作　　者：朱长太 李玲 李志强 宛新建[3] 陈世耀[11] 潘健 张奕[1] 任翔 韩坤 邹锋 文爱清 戎瑞明[8,13] 夏荣 钱宝华[6,13] 马昕 ZHU Changtai;LI Ling;LI Zhiqiang;WAN Xinjian;CHEN Shiyao;PAN Jian;ZHANG Yi;REN Xiang;HAN Kun;ZOU Feng;WEN Aiqing;RONG Ruiming;XIA Rong;QIAN Baohua;MA Xin(Department of Blood Transfusion,Shanghai Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200233,China;Department of Orthopedics,Shanghai Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200233,China;Department of Gastroenterology,Shanghai Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200233,China;Department of Oncology,Shanghai Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200233,China;Department of Anesthesiology,Shanghai Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200233,China;Department of Transfusion Medicine,First Affiliated Hospital of Navy University,Shanghai 200433,China;Department of Transfusion Medicine,Huashan Hospital Affiliated to Fudan University,Shanghai 200040,China;Department of Transfusion Medicine,Zhongshan Hospital Affiliated to Fudan University,Shanghai 200032,China;Southwest Jiaotong University Affiliated Hospital,Chengdu Third People′s Hospital,Chengdu,Sichuan 610031,China;Editorial Department of"Clinical Transfusion and Laboratory Medicine,"First Affiliated Hospital of University of Science and Technology of China,Hefei,Anhui 230001,China;Evidence-Based Medicine Center,Fudan University,Shanghai 200032,China;Department of Transfusion Medicine,National Key Laboratory of Trauma and Chemical Poisoning,Daping Hospital,Army Medical University,Chongqing 400042,China;Shanghai Medical Association,Transfusion Medicine Branch,Shanghai 200040,China;Clinical Transfusion Management Committee,Chinese Society of Blood Transfusion,Beijing 100088200051,China)

机构地区：[1]上海交通大学医学院附属上海第六人民医院输血科,上海200233 [2]上海交通大学医学院附属上海第六人民医院骨科,上海200233 [3]上海交通大学医学院附属上海第六人民医院消化内科,上海200233 [4]上海交通大学医学院附属上海第六人民医院肿瘤科,上海200233 [5]上海交通大学医学院附属上海第六人民医院麻醉科,上海200233 [6]海军军医大学第一附属医院输血医学科,上海200433 [7]复旦大学附属华山医院输血医学科,上海200040 [8]复旦大学附属中山医院输血医学科,上海200032 [9]西南交通大学附属医院/成都市第三人民医院输血科,四川成都610031 [10]中国科学技术第一附属医院《临床输血与检验》编辑部,安徽合肥230001 [11]复旦大学循证医学中心,上海200032 [12]陆军军医大学大坪医院输血医学科创伤与化学中毒全国重点实验室,重庆400042 [13]上海市医学会输血专科分会,上海200040 [14]中国输血协会临床输血管理专委会,北京100088

出　　处：《中国输血杂志》2025年第2期149-167,共19页Chinese Journal of Blood Transfusion

基　　金：国家自然基金资助项目(82270789);上海市申康医院发展中心临床创新项目(SHDC12015910);上海市第六人民医院特色学科项目(院学科2020014)。

摘　　要：术中自体血回输(IOCS)作为1种重要的血液保护措施在外科手术中得到了广泛地应用。但目前国内外尚缺乏恶性肿瘤患者实施IOCS的临床实践指南。本研究旨在根据对现有证据的查阅和评估,为临床在恶性肿瘤患者手术中应用IOCS提供建议。研究数据来源于PubMed、Embase、Cochrane图书馆、万方等数据库。指南制定团队根据证据质量、利弊权衡、患者意愿和卫生经济学评估形成建议。本研究构建了7个临床问题,指南主要结论如下:1)与无围手术期异体输血(NPABT)相比,围手术期异体输血(PABT)会引起恶性肿瘤患者更为不利的预后(推荐);2)同输入异体血或未输血比较,实施IOCS不会引起恶性肿瘤患者更为不利的预后(推荐);3)肿瘤患者实施IOCS是经济可行的(推荐);4)恶性肿瘤患者实施IOCS应该使用去白细胞过滤器(LDF)(强推荐);5)恶性肿瘤患者实施IOCS可以使用射线照射处理待回输的自体血(推荐);6)实施IOCS前应详细评估恶性肿瘤患者病情(符合适应证并排除禁忌证),方可实施IOCS(强推荐);7)恶性肿瘤患者实施IOCS应取得患者的知情同意,充分地对患者病情和失血可能性进行预评估并遵守经内部审核的标准化管理流程,满足相应的条件,并应取得相应的资质(推荐)。总之,目前的证据表明:对某些需要输异体血的恶性肿瘤患者经过医师充分评估后可实施IOCS,实施过程中应使用LDF或者射线照射。Intraoperative cell salvage(IOCS)has been widely applied as an important blood conservation measure in surgical operations.However,there is currently a lack of clinical practice guidelines for the implementation of IOCS in patients with malignant tumors.This report aims to provide clinicians with recommendations on the use of IOCS in patients with malignant tumors based on the review and assessment of the existed evidence.Data were derived from databases such as PubMed,Embase,the Cochrane Library and Wanfang.The guideline development team formulated recommendations based on the quality of evidence,balance of benefits and harms,patient preferences,and health economic assessments.This study constructed seven major clinical questions.The main conclusions of this guideline are as follows:1)Compared with no perioperative allogeneic blood transfusion(NPABT),perioperative allogeneic blood transfusion(PABT)leads to a more unfavorable prognosis in cancer patients(Recommended);2)Compared with the transfusion of allogeneic blood or no transfusion,IOCS does not lead to a more unfavorable prognosis in cancer patients(Recommended);3)The implementation of IOCS in cancer patients is economically feasible(Recommended);4)Leukocyte depletion filters(LDF)should be used when implementing IOCS in cancer patients(Strongly Recommended);5)Irradiation treatment of autologous blood to be reinfused can be used when implementing IOCS in cancer patients(Recommended);6)A careful assessment of the condition of cancer patients(meeting indications and excluding contraindications)should be conducted before implementing IOCS(Strongly Recommended);7)Informed consent from cancer patients should be obtained when implementing IOCS,with a thorough pre-assessment of the patient′s condition and the likelihood of blood loss,adherence to standardized internally audited management procedures,meeting corresponding conditions,and obtaining corresponding qualifications(Recommended).In brief,current evidence indicates that IOCS can be implemented for some mali

关 键 词：术中自体血回输(IOCS) 自体输血 恶性肿瘤 手术 指南 

分 类 号：R457.1[医药卫生—治疗学] R73[医药卫生—临床医学] R61