小容量血液稀释对心脏手术患者围术期临床结局影响的研究

发布时间：2019-02-27 19:45

【摘要】：目的:回顾性评价术中使用小容量急性等容性血液稀释(acute normovolemic hemodilution,ANH)对行体外循环(cardiopulmonary bypass,CPB)心脏手术患者术中红细胞等血制品使用情况以及住院期间死亡率、机械通气时间、ICU住院时间、术后住院时间和其它临床结局情况的各种影响。方法:通过查阅浙江大学医学院附属第二医院电子病例,回顾性研究自2010年1月～2015年5月2058例体外循环下的心脏手术患者。依照术前是否使用ANH分2组:ANH组和非ANH组。我们分析小容量ANH和围术期结局的相关性。数据库收集的数据其中包括了术前的一般资料、术中各项指标和术后的观察指标。术前的一般资料包括患者年龄、身高、性别、体重、既往用药情况、既往病史。术中相关指标包括手术时间、体外循环时间、主动脉阻断时间、手术类型和手术方式。主要观察指标为术中红细胞输注率;次要观察指标包括其它围术期血制品输注率和量,术后肺部感染率,住院期间死亡率,脑卒中,新发房颤,因大出血再次手术,急性肾功能衰竭,机械通气时间,ICU住院天数,术后住院天数和其它临床结局。结果:倾向性匹配前一共有1289名患者纳入本研究,其中有358例患者在术前接受ANH,931例患者术前未行ANH。在1289名患者中,其中有38.8%(500例)患者在围术期进行红细胞输注,10%(129例)患者进行血小板输注,56.4%(727例)进行新鲜冰冻血浆输注。按1:1倾向值匹配后总共708例配对成功,每组均有354例患者,匹配后两组患者的术前一般情况资料与术中情况差异均无统计学意义。进行倾向性匹配后,与非ANH组相比,ANH组术中红细胞输注率(8.5%vs.14.4%;P=0.013),红细胞输注量(164 ml vs.289 ml;P=0.019),以及术后肺部感染发生率(6.8 vs.11.3%;P=0.036)均明显降低。但两组间的冰冻血浆输注率、血小板输注率以及术后异体血输注率差异并没有统计学意义。两组间包括死亡率、切口愈合延长发生率、脑梗塞发病率、新发房颤发生率、因大出血而再次手术率、急性肾功能损伤发生率、术后机械通气时间、ICU停留时间差异均无统计学意义。结论:在本回顾性研究中,体外循环下的心脏手术前采用小容量急性等容性血液稀释,能有效降低心脏手术病人在术中的红细胞输注率和术后肺部感染发生率。但对术后及术中异体输血情况、急性肾功能损伤发生率及住院时间、术后死亡率、ICU停留时间无明显影响。
[Abstract]:Objective: to retrospectively evaluate the use of small volume acute normovolemic hemodilution (acute normovolemic hemodilution,ANH) during heart surgery with cardiopulmonary bypass (cardiopulmonary bypass,CPB) in patients with erythrocytes and other blood products and the mortality rate during hospitalization. Effects of mechanical ventilation duration, length of stay in ICU, postoperative hospitalization time and other clinical outcomes. Methods: 2058 patients undergoing cardiac surgery under cardiopulmonary bypass (CPB) from January 2010 to May 2015 were retrospectively studied by referring to the electronic cases in the second affiliated Hospital of Zhejiang University Medical College. According to whether to use ANH before operation, they were divided into two groups: ANH group and non-ANH group. We analyzed the correlation between small volume ANH and perioperative outcome. The data collected in the database included pre-operative general data, intraoperative and postoperative observations. Pre-operative data include age, height, sex, weight, past medication, and previous medical history. The operative parameters included operation time, cardiopulmonary bypass time, aortic cross-clamping time, operation type and operation mode. The main outcome measures were intraoperative red blood cell infusion rate; Secondary outcome measures included other perioperative blood transfusion rates and quantities, postoperative pulmonary infection rate, mortality during hospitalization, stroke, new atrial fibrillation, reoperation due to massive hemorrhage, acute renal failure, duration of mechanical ventilation, days of hospitalization of ICU. Postoperative hospital stay and other clinical outcomes. Results: a total of 1289 patients were enrolled in the study before predisposition matching. Among them, 358 patients received ANH,931 before operation and no ANH. was performed before operation. Of the 1289 patients, 38.8% (500 cases) received peri-operative red blood cell infusion, 10% (129 cases) received platelet transfusion, and 56.4% (727 cases) received fresh frozen plasma infusion. A total of 708 matched patients were successfully matched according to the 1:1 tendency value, and 354 patients in each group. There was no significant difference between the preoperative and intraoperative data of the two groups after the match. Compared with the non-ANH group, the intraoperative erythrocyte infusion rate (8.5% vs. 14.4%) and erythrocyte transfusion volume (164 ml vs.289 ml;) in the ANH group were compared with those in the non-ANH group. P0. 019) and postoperative pulmonary infection rate (6. 8 vs.11.3%;P=0.036) were significantly lower than those of control group (P < 0. 019). However, there was no significant difference in frozen plasma infusion rate, platelet transfusion rate and allogeneic blood transfusion rate between the two groups. The two groups included mortality rate, rate of wound healing prolongation, incidence of cerebral infarction, incidence of new atrial fibrillation, re-operation rate due to massive hemorrhage, incidence of acute renal function injury, time of postoperative mechanical ventilation, There was no significant difference in the stay time of ICU. Conclusion: in this retrospective study, small volume acute normovolemic hemodilution before cardiac surgery under cardiopulmonary bypass can effectively reduce the rate of red blood cell transfusion and the incidence of postoperative pulmonary infection in patients undergoing cardiac surgery. However, there was no significant effect on the postoperative and intraoperative allogeneic blood transfusion, the incidence of acute renal function injury, the length of hospitalization, the postoperative mortality and the stay time of ICU.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614
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本文编号：2431523