Shevde Ketan, Pagala Murali, Tyagaraj Changa, Udeh Chiedozie, Punjala Mamatha, Arora Sunita, Elfaham Abdelhamid
Department of Anesthesiology, Maimonides Medical Center, Brooklyn, NY 12119, USA.
J Clin Anesth. 2002 Nov;14(7):512-7. doi: 10.1016/s0952-8180(02)00423-3.
To evaluate whether preoperative blood volume and postoperative blood loss influence blood transfusion in females and males undergoing coronary artery bypass graft (CABG) surgery.
Prospective study.
Anesthesiology department of a teaching hospital.
57 CABG patients (21 females and 36 males).
Blood volume was determined using the radioactivity dilution method. Preoperatively, each patient received intravenous (IV) injection of 1 mL Albumin I(131) tracer having 25 microcuries of radioactivity. Five-milliliter blood samples were collected at different intervals. From these samples, hematocrit (Hct) value, preoperative total blood volume, red blood cell (RBC) volume, and plasma volume were determined. Postoperatively, some consenting patients received another 1 mL dose of the tracer, and the postoperative blood volumes were determined. If a patient received a blood transfusion, the units of packed red blood cells (PRBCs), platelets, or fresh frozen plasma (FFP) transfused were recorded. For each patient we recorded the gender, age, weight, height, body surface area (BSA), preoperative Hct, duration of surgery, and discharge Hct.
Preoperatively, the mean total blood volume, RBC volume, and plasma volume, respectively, were 2095 mL/m(2), 631 mL/m(2), and 1,465 mL/m(2) in females; and 2,580 mL/m(2), 878 mL/m(2), and 1,702 mL/m(2) in males. The preoperative blood volumes were significantly lower (p < 0.01) in females than in males. There was no significant difference between males and females in the extent of blood loss during CABG. Intraoperatively, females received PRBC transfusion of 1.38 units, significantly more (p < 0.01) than the 0.39 units received by males. During the entire hospital stay, females received 4.33 units of PRBC, significantly more than (p < 0.02) the 1.33 units received by males. Significantly more (p < 0.01) females (12 of 21) received intraoperative PRBC transfusion than did males (6 of 36). Multiple logistic regression analysis of the data showed that PRBC transfusion was significantly correlated with the preoperative total blood volume and RBC volume.
The greater need for blood transfusion in females than in males during CABG is primarily attributable to significantly lower preoperative total blood volume and RBC volume in females.
评估术前血容量和术后失血是否会影响接受冠状动脉搭桥术（CABG）的女性和男性患者的输血情况。
前瞻性研究。
一家教学医院的麻醉科。
57例CABG患者（21名女性和36名男性）。
采用放射性稀释法测定血容量。术前，每位患者静脉注射1 mL含有25微居里放射性的白蛋白I（131）示踪剂。在不同时间间隔采集5毫升血样。从这些样本中，测定血细胞比容（Hct）值、术前总血容量、红细胞（RBC）容量和血浆容量。术后，部分同意的患者再接受1 mL剂量的示踪剂，测定术后血容量。如果患者接受输血，记录输注的浓缩红细胞（PRBC）、血小板或新鲜冰冻血浆（FFP）的单位数。对于每位患者，我们记录了性别、年龄、体重、身高、体表面积（BSA）、术前Hct、手术持续时间和出院时的Hct。
术前，女性的平均总血容量、RBC容量和血浆容量分别为2095 mL/m²、631 mL/m²和1465 mL/m²；男性分别为2580 mL/m²、878 mL/m²和1702 mL/m²。女性术前血容量显著低于男性（p < 0.01）。CABG期间，男性和女性的失血量无显著差异。术中，女性接受1.38单位的PRBC输血，显著多于男性接受的0.39单位（p < 0.01）。在整个住院期间，女性接受4.33单位的PRBC，显著多于男性接受的1.33单位（p < 0.02）。接受术中PRBC输血的女性（21例中的12例）显著多于男性（36例中的6例）（p < 0.01）。对数据进行多因素逻辑回归分析表明，PRBC输血与术前总血容量和RBC容量显著相关。
CABG期间女性比男性对输血的需求更大，主要归因于女性术前总血容量和RBC容量显著较低。
