Ovrum Eivind, Tangen Geir, Oystese Rolf, Ringdal Mari Anne L, Istad Reidar
Oslo Heart Center, Oslo, Norway.
J Card Surg. 2003 Mar-Apr;18(2):140-6. doi: 10.1046/j.1540-8191.2003.02007.x.
Introduction of completely heparin-coated cardiopulmonary bypass (CPB) circuits combined with reduced systemic anticoagulation has been shown to reduce postoperative bleeding and requirements for allogeneic transfusions after cardiac surgery. However, some uncertainty exists whether this effect is due to the reduced amount of heparin or to the heparinized surface itself. Therefore, a retrospective study was undertaken, comparing two different anticoagulation protocols applied to coronary artery bypass patients treated with identical heparin-coated CPB equipment.
Over a 12 month period all coronary artery bypass patients operated with extracorporeal circulation were subjected to a Duraflo II heparin-coated circuit (Baxter Healthcare Corp, Bentley Laboratories Division, Irvine, Calif) and full heparin dose (activated clotting time [ACT] > 480 seconds; Group F, n = 651). Over the next 24 months, all coronary patients who were treated with an identical circuit combined with reduced systemic heparinization (ACT > 250 seconds) were included in Group R (n = 675). Except for the different anticoagulation protocols, all treatment regimens before, during, and after the operation remained unchanged throughout the study period.
There were no statistically significant differences in any major demographic or operative parameters. In Group R, the postoperative bleeding was mean 665 +/- 257 ml versus 757 +/- 367 ml in Group F (p < 0.0001), and the perioperative decrease in hemoglobin concentration was significantly lower in Group R (22 +/- 1.2 gm/L versus 25 +/- 1.3 gm/L, p < 0.0001). The time for postoperative ventilatory support was shorter in Group R (1.7 +/- 1.3 hours versus 1.9 +/- 1.1 hours in Group F, p = 0.0006), and the incidence of new episodes of atrial fibrillation after the operation was lower (26.4% in Group R versus 32.8% in Group F, p = 0.01). There were no significant differences in the incidences of perioperative myocardial infarction, stroke, transient neurological disturbances, physical rehabilitation, or mortality. No technical or coagulation problems were recorded in either group.
The use of Duraflo II coated circuits for CPB combined with reduced anticoagulation decrease postoperative bleeding and hemoglobin loss compared with full heparin dose treatment. In addition, the intubation time was shorter and the incidence of postoperative atrial fibrillation was lower in the patients treated with low heparin doses.
完全肝素涂层体外循环（CPB）回路与减少全身抗凝相结合的应用已被证明可减少心脏手术后的术后出血和异体输血需求。然而，这种效果是由于肝素用量减少还是肝素化表面本身所致尚存在一些不确定性。因此，我们进行了一项回顾性研究，比较应用于接受相同肝素涂层CPB设备治疗的冠状动脉搭桥患者的两种不同抗凝方案。
在12个月期间，所有接受体外循环手术的冠状动脉搭桥患者均使用Duraflo II肝素涂层回路（百特医疗保健公司，本特利实验室部门，加利福尼亚州欧文）并给予全量肝素剂量（活化凝血时间[ACT]>480秒；F组，n = 651）。在接下来的24个月中，所有使用相同回路并减少全身肝素化（ACT>250秒）治疗的冠状动脉患者被纳入R组（n = 675）。除了不同的抗凝方案外，在整个研究期间，手术前、手术中和手术后的所有治疗方案均保持不变。
在任何主要人口统计学或手术参数方面均无统计学显著差异。在R组中，术后出血量平均为665±257 ml，而F组为757±367 ml（p<0.0001），R组围手术期血红蛋白浓度的下降明显更低（22±1.2 g/L对25±1.3 g/L，p<0.0001）。R组术后通气支持时间更短（1.7±1.3小时对F组的1.9±1.1小时，p = 0.0006），术后新发房颤的发生率更低（R组为26.4%，F组为32.8%，p = 0.01）。围手术期心肌梗死、中风、短暂性神经功能障碍及身体康复或死亡率的发生率无显著差异。两组均未记录到技术或凝血问题。
与全量肝素剂量治疗相比，CPB使用Duraflo II涂层回路并减少抗凝可减少术后出血和血红蛋白丢失。此外，低肝素剂量治疗的患者插管时间更短，术后房颤发生率更低。
