More than two months ago, an 82-year-old gentleman received a coronary artery bypass graft in the Department of Cardiovascular Surgery of the First Hospital of Harbin Medical University by Professor Liu Hongyu, the head of the department, and was discharged from the hospital seven days later. At present, the annual per capita input of red blood cells for surgical patients in this department is controlled within 2.5 units, which has reached the advanced level in China. By using blood scientifically and rationally, it has not only reduced the occurrence of blood transfusion-related complications, but also solved the national blood shortage situation. Liu Hongyu, Department of Cardiovascular Surgery, The First Hospital of Harbin Medical University
In China, cardiac major vascular surgery, as the traditional major user of clinical blood, the transfusion rate is generally above 80%, while the transfusion rate of pediatric and elderly people even exceeds 90%. The blood donation rate in China is only 0.87%, which is lower than the warning line of 1% of the World Health Organization. The “blood shortage” has become a bottleneck for surgery. Moreover, because there are no strict rules and standards for the reasonable dose of blood transfusion, unreasonable blood transfusion is common in many hospitals. According to a report, the results of a survey on the current situation of reasonable blood use in several tertiary hospitals in China show that unreasonable blood use reaches 20%-30%, while the results of a survey on blood transfusion knowledge show that doctors have only 67% correct rate.
At the same time, clinical blood transfusion is a double-edged sword that can lead to a variety of complications, such as fever, allergy, hemolytic reactions; infection with blood-borne diseases (AIDS, viral hepatitis, syphilis, malaria, etc.); immunosuppression may also occur, increasing the probability of postoperative infection; immune reactions between donor and recipient due to blood transfusion can cause transfusion-related graft-versus-host disease; blood transfusion can increase acute lung injury, circulatory Transfusion can increase serious complications such as acute lung injury, circulatory overload, hypothermia, alkalosis, hypocalcemia and coagulation abnormalities, thus increasing the risk and uncertainty of patient death. Therefore, the use of blood not in accordance with the provisions of a hundred harm rather than good, strict grasp of the indications for blood transfusion, reduce incorrect blood transfusion, as far as possible to achieve no blood transfusion, less blood transfusion, become a clinical imperative.
Under such a premise, how does the Department of Cardiac and Macrovascular Surgery of Harbin Medical University First Hospital “open source and cut costs” and reduce the amount of clinical blood transfusion to a record low? Professor Liu Hongyu and his medical team actively advocate the new concept and viewpoint of blood conservation, strictly control blood transfusion and transfusion volume from preoperative, intraoperative and postoperative aspects, and practice “bloodless surgery”, “scientific blood use” and “efficient blood transfusion” to the maximum extent. “In other words, we actively correct anemia before surgery, make good preoperative preparation, and reduce the chance of transfusion during and after surgery; strictly stop bleeding during surgery, do not leave “hidden danger”, and try to eliminate the occurrence of postoperative bleeding; implement quality care after surgery, and promote the patient’s postoperative care to promote the recovery of the patient’s body.
In recent years, under the efforts of Prof. Liu Hongyu, the Department of Cardiac and Macrovascular Surgery of Harbin Medical University has introduced a series of new technologies into the clinic, fundamentally reversing the status quo of traditional cardiac surgery with many blood transfusions. In the past, most of the operations in cardiac surgery were performed under extracorporeal circulation, which inevitably increased the amount of clinical blood transfusion, but now the majority of congenital heart surgery adopts surgical minimally invasive blocking means (such as minimally invasive blocking of congenital ventricular septal defect and congenital atrial septal defect), which not only does not require extracorporeal circulation, but also greatly reduces the operation time and largely reduces the proportion of clinical blood consumption, which was unimaginable in the past. This was unimaginable in the past. In addition, small-incision surgery (small-incision valve replacement, small-incision Bentall, small-incision atrial septal defect repair, small-incision myocardial bridge release), full thoracoscopic surgery (atrial septal defect repair, tricuspid valvuloplasty, pulmonary valve stenosis junctional dissection, partial endocardial cushion defect correction, cardiac mucinous tumor removal), and non-extracorporeal circulation heart non-stop coronary artery bypass grafting and other conventional methods The rapid development of these methods has curbed the growth of clinical blood use at the source.
It is an indisputable fact that traditional aortic coarctation is one of the most blood-intensive cardiac surgical procedures, and “blood flow” and “bloodbath” were once used to describe the scene of the operator facing such an incision. With the application of several innovative techniques of aortic coarctation in the Department of Cardiovascular Surgery of Harbin Medical University, such as the intracavitary repair of thoracic aorta, hybridization surgery and the control of perfusion and surgical temperature of extracorporeal circulation in Stanford A-type aortic coarctation, the amount of blood transfusion related to surgery has been significantly reduced, which has completely changed people’s traditional concept. They have also actively promoted the concept of non-invasive extracorporeal circulation and the use of bloodless preflushing, which has further reduced the “tide” of intraoperative blood consumption.
For patients who cannot avoid blood transfusion, Prof. Liu Hong Yu asks the doctors in the department to be fully prepared to use the patient’s own blood as much as possible and reduce the input of allogeneic blood. In many developed countries, 20-40% of total blood transfusions are now autologous, and in Australia and the United States the proportion of autologous transfusions even accounts for 80-90%. The autologous blood transfusion vigorously promoted in these countries effectively avoids complications such as infections and immune deficiency brought about by allogeneic blood transfusion. In Prof. Liu’s ward, the same situation can be seen everywhere. In patients with tetralogy of Fallot, who have high hematocrit before surgery, pre-storage autologous blood transfusion is used to improve microcirculation, and autologous blood transfusion can be done intraoperatively or postoperatively, so it can be said to “kill two birds with one stone” and “make a difference”. For “major surgery” with a lot of bleeding, such as aortic coarctation, an intraoperative autologous blood recovery machine is used to perform a recovery type of autologous blood transfusion. Before entering anesthesia, we also collect blood from patients and apply diluted autologous transfusion. In the postoperative period, they strictly grasp the indications for blood transfusion, and strictly comply with the Ministry of Health’s 2000 blood transfusion guidelines, which stipulate that no transfusion should be given for hemoglobin >100g/l, that concentrated red blood cells should be given for hemoglobin <70g/l, and that blood transfusion should be given for hemoglobin between 70 and 100g/l, depending on the patient's specific situation. They also continue to increase their efforts to promote science in the clinic to doctors, patients and their families, changing the traditional misconception of relying on transfusion of blood products to replenish nutrition, speed up tissue healing, increase blood volume and raise colloid osmotic pressure.
“It is believed that with the continuous exploration and popularization of new technologies, new concepts and new methods, clinical blood consumption will continue to decrease, blood resources will be more rationally allocated and scientifically, effectively and safely utilized, and the era of bleeding-free surgery will be closer and closer to us!” Professor Liu Hongyu commented optimistically.