DeFoe G R, Ross C S, Olmstead E M, Surgenor S D, Fillinger M P, Groom R C, Forest R J, Pieroni J W, Warren C S, Bogosian M E, Krumholz C F, Clark C, Clough R A, Weldner P W, Lahey S J, Leavitt B J, Marrin C A, Charlesworth D C, Marshall P, O'Connor G T
Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA.
Ann Thorac Surg. 2001 Mar;71(3):769-76. doi: 10.1016/s0003-4975(00)02393-6.
Cardiac surgery patients' hematocrits frequently fall to low levels during cardiopulmonary bypass.
We investigated the association between nadir hematocrit and in-hospital mortality and other adverse outcomes in a consecutive series of 6,980 patients undergoing isolated coronary artery bypass graft surgery. The lowest hematocrit during cardiopulmonary bypass was recorded for each patient. Patients were divided into categories based on their lowest hematocrit. Women had a lower hematocrit during bypass than men but both sexes are represented in each category.
After adjustment for preoperative differences in patient and disease characteristics, the lowest hematocrit during cardiopulmonary bypass was significantly associated with increased risk of in-hospital mortality, intra- or postoperative placement of an intraaortic balloon pump and return to cardiopulmonary bypass after attempted separation. Smaller patients and those with a lower preoperative hematocrit are at higher risk of having a low hematocrit during cardiopulmonary bypass.
Female patients and patients with smaller body surface area may be more hemodiluted than larger patients. Minimizing intraoperative anemia may result in improved outcomes for this subgroup of patients.
心脏手术患者在体外循环期间血细胞比容常常降至低水平。
我们调查了6980例接受单纯冠状动脉旁路移植术患者的最低血细胞比容与住院死亡率及其他不良结局之间的关联。记录每位患者体外循环期间的最低血细胞比容。根据最低血细胞比容将患者分类。女性在体外循环期间的血细胞比容低于男性，但每个类别中均有两性患者。
在对患者和疾病特征的术前差异进行校正后，体外循环期间的最低血细胞比容与住院死亡率增加、主动脉内球囊泵在术中或术后的置入以及在尝试脱离后返回体外循环的风险显著相关。体型较小的患者以及术前血细胞比容较低的患者在体外循环期间出现低血细胞比容的风险更高。
女性患者和体表面积较小的患者可能比体型较大的患者血液稀释程度更高。尽量减少术中贫血可能会改善这一亚组患者的结局。
