1.THE CLINICAL STUDY OF 17-L-CRYSTALLINE AMINO ACIDS SOLUTION IN PATIENTS WITH CARCINOMA OF ESOPHAGUS AND CARDIA AFTER RESECTION
Wenhan QIN ; Kexian YANG ; Shijie WAN
Acta Nutrimenta Sinica 1956;0(01):-
Protein synthesis and nitrogen equilibrium have been investigated in the early postoperative period in 21 patients with carcinoma of esophagus and cardia after resection. They received 17-L-crystalline amino acid (AAM) and glucose infusion through parenteral route and were compared with a series' of 11 patients taking similar volume and calorie with protein hydrolysate (PRH) and glucose.In AAM series, the plasma protein could be maintained in preoperatiye level but not in PRH series. In AAM series a nitrogen equilibrium was reached while in PRH series was a negative equilibrium. The cellular immunity and serum amino acid spectrum were improved or replaced in both series, but they were better in AAM series. The improvement in nitrogen balance was probably mainly due to an increase in protein synthesis.
2.Individualized red-cell transfusion strategy for non-cardiac surgery in adults: a randomized controlled trial.
Ren LIAO ; Jin LIU ; Wei ZHANG ; Hong ZHENG ; Zhaoqiong ZHU ; Haorui SUN ; Zhangsheng YU ; Huiqun JIA ; Yanyuan SUN ; Li QIN ; Wenli YU ; Zhen LUO ; Yanqing CHEN ; Kexian ZHANG ; Lulu MA ; Hui YANG ; Hong WU ; Limin LIU ; Fang YUAN ; Hongwei XU ; Jianwen ZHANG ; Lei ZHANG ; Dexing LIU ; Han HUANG
Chinese Medical Journal 2023;136(23):2857-2866
BACKGROUND:
Red-cell transfusion is critical for surgery during the peri-operative period; however, the transfusion threshold remains controversial mainly owing to the diversity among patients. The patient's medical status should be evaluated before making a transfusion decision. Herein, we developed an individualized transfusion strategy using the West-China-Liu's Score based on the physiology of oxygen delivery/consumption balance and designed an open-label, multicenter, randomized clinical trial to verify whether it reduced red cell requirement as compared with that associated with restrictive and liberal strategies safely and effectively, providing valid evidence for peri-operative transfusion.
METHODS:
Patients aged >14 years undergoing elective non-cardiac surgery with estimated blood loss > 1000 mL or 20% blood volume and hemoglobin concentration <10 g/dL were randomly assigned to an individualized strategy, a restrictive strategy following China's guideline or a liberal strategy with a transfusion threshold of hemoglobin concentration <9.5 g/dL. We evaluated two primary outcomes: the proportion of patients who received red blood cells (superiority test) and a composite of in-hospital complications and all-cause mortality by day 30 (non-inferiority test).
RESULTS:
We enrolled 1182 patients: 379, 419, and 384 received individualized, restrictive, and liberal strategies, respectively. Approximately 30.6% (116/379) of patients in the individualized strategy received a red-cell transfusion, less than 62.5% (262/419) in the restrictive strategy (absolute risk difference, 31.92%; 97.5% confidence interval [CI]: 24.42-39.42%; odds ratio, 3.78%; 97.5% CI: 2.70-5.30%; P <0.001), and 89.8% (345/384) in the liberal strategy (absolute risk difference, 59.24%; 97.5% CI: 52.91-65.57%; odds ratio, 20.06; 97.5% CI: 12.74-31.57; P <0.001). No statistically significant differences were found in the composite of in-hospital complications and mortality by day 30 among the three strategies.
CONCLUSION:
The individualized red-cell transfusion strategy using the West-China-Liu's Score reduced red-cell transfusion without increasing in-hospital complications and mortality by day 30 when compared with restrictive and liberal strategies in elective non-cardiac surgeries.
TRIAL REGISTRATION
ClinicalTrials.gov, NCT01597232.
Humans
;
Adult
;
Postoperative Complications
;
Erythrocyte Transfusion/adverse effects*
;
Blood Transfusion
;
Hospitals
;
Hemoglobins/analysis*