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Vol. 74. Issue 2.
Pages 62-68 (August 2003)
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Vol. 74. Issue 2.
Pages 62-68 (August 2003)
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Guías para la reposición de las pérdidas sanguíneas en cirugía abdominal de urgencia
Guidelines for blood loss replacement in emergency abdominal surgery
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Manuel García-Caballero1,a, Eliseo Villagrasab, José Manuel Martínez-Morenoc, Manuel Muñozd, Ana Calderóne, José Antonio Carmonaf, José Antonio Villalobos Talerog
a Profesor Titular de Cirugía. Departamento de Cirugía. Facultad de Medicina. Universidad de Málaga
b Cirugía General. Servicio de Cirugía. Hospital Universitario Virgen de la Victoria. Málaga
c Becario de Proyecto FIS. Departamento de Cirugía. Facultad de Medicina. Universidad de Málaga. Málaga
d Coordinador GIEMSA. Prof. Titular de Bioquímica y Biología Molecular. Facultad de Medicina. Universidad de Málaga. Málaga
e Departamento de Cirugía. Facultad de Medicina. Universidad de Málaga. Málaga
f Servicio de Anestesia. Hospital Universitario Virgen de la Victoria. Málaga
g Jefe de Sección de Cirugía General. Hospital Universitario Virgen de la Victoria. Málaga. España
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Resumen

La reposición de la pérdidas sanguíneas en cirugía abdominal urgente desempeña un papel clave para la supervivencia, sobre todo en los pacientes que presentan una pérdida de sangre masiva provocada por la rotura del hígado, el bazo y los vasos mesentéricos, así como en el hemoperitoneo masivo secundario a un embarazo ectópico.

Para manejar con éxito a estos pacientes debe seguirse un algoritmo claro previamente consensuado y aceptado por los miembros del servicio, tanto para el rápido diagnóstico y utilización de maniobras quirúrgicas precisas para el control de la fuente de hemorragia como, sobre todo, para el control de la alteración de los factores de la coagulación y la consecuente necesidad de una precisa pauta de uso de los distintos componentes sanguíneos que deben utilizarse en su reposición. El uso de estas guías reduce la mortalidad de forma significativa.

En este contexto, el uso de la autotransfusión intraoperatoria ha demostrado ser un procedimiento seguro y con un buena relación coste-efectividad que se puede utilizar incluso por vía laparoscópica. Sin embargo, su utilización está poco extendida, sistematizada y mal organizada, a tenor de los datos publicados en la bibliografía.

Palabras clave:
Hemorragia masiva
Cirugía abdominal urgente
Transfusión masiva
Alteración de los factores de la coagulación
Autotransfusión intraoperatoria

Replacement of blood loss in emergency abdominal surgery plays a key role in survival, especially in patients with massive blood loss due to rupture of the liver, spleen or mesenteric vessels, as well as in massive hemoperitoneum due to ectopic pregnancies.

To successfully manage these patients, a clear algorithm, previously consensuated and approved by the surgical staff, both for rapid diagnosis and use of the surgical procedures needed to control the source of bleeding should be followed. Precise criteria are especially required to control alterations in coagulation factors and the consequent need for the distinct blood components that should be used in replacement.

In this context, the use of intraoperative autotransfusion has been demonstrated to be safe and cost-effect. This procedure can even be used in laparoscopic surgery. However, data published in the literature indicate that this technique is not widely or systematically used and that it is poorly organized.

Key words:
Massive hemorrhage
Emergency abdominal surgery
Massive transfusion
Alterations in coagulation factors
Intraoperative autotransfusion
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Copyright © 2003. Asociación Española de Cirujanos
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