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환자혈액관리 관점에서 본 수술 환자의 빈혈 처치법

Perioperative Management of Anemia Based on Patient Blood Management

대한수혈학회지 2020년 31권 1호 p.21 ~ 33
고재환 ( Koh Jae-Whoan ) - Inje University College of Medicine Ilsan Paik Hospital Department of Obstetrics and Gynecology

Abstract


Perioperative anemia is common during surgery and is an important risk factor for the transfusion of RBC, morbidity and mortality. Blood transfusion has been a common practice for a long time, and has been a traditionally accepted solution to perioperative anemia. However, increasing evidence is now showing that this traditional treatment may actually do more harm than good. Research has shown that transfusion is independently associated with morbidity and mortality. A paradigm shift is currently taking place towards patient-oriented blood management and patient blood management, PBM. PBM consists of 3 pillars: the optimization of the red blood cell mass, reduction of blood loss and bleeding, and optimization of the patients’ physiological tolerance toward anemia. Of the three fillers, perioperative management is mainly included in the second pillar, but integration of these 3 pillars and strategies into perioperative pathways should improve care processes and patient outcome. Bleeding during surgery and efforts to stop it continue, and treatment for bleeding and many hemostatic methods have been developed. In recent decades, minimally invasive surgical techniques have led to a reduction of bleeding, where hemostatic agents, surgical instruments and new techniques have played an important role in the perioperative field of PBM. This paper summarized why PBM is needed, and the strategy during surgery simply and easily. This paper focuses on the surgeons’ role in PBM. The main PBM protocol is not discussed, but rather the paper focuses on selective clinical practice.

키워드

Perioperative anemia; Bleeding; Patient blood management
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