Perthel M, Klingbeil A, El-Ayoubi L, Gerick M, Laas J
Herz-und Gefäbzentrum Bad Bevensen, Division of Cardiothoracic Surgery, Römstedter Strasse 25, 29549 Bad Bevensen, Germany.
Perfusion. 2007 Jan;22(1):9-14. doi: 10.1177/0267659106075660.
The objective of this study is to investigate the hypothesis that a reduced prime extracorporeal circulation (ECC) system and ensuing reduction in patient hemodilution can affect blood product use.
We performed a prospective, randomized study from a group of 60 consecutive coronary artery bypass graft (CABG) patients, comparing blood product usage and postoperative bleeding in 30 mini bypass systems (n = 30) to 30 conventional systems (n = 30). The patient demographics in terms of patient weight, height, age, preoperative hemoglobin, preoperative hematocrit, BSA, ejection fraction, and NYHA were not statistically significant.
Blood product use, including fresh frozen plasma (FFP) and homolgous blood transfusions was tracked through the operating theater and into the intensive care unit. In the mini bypass group, while no homologous blood transfusions were given in the OR, 27% of the patients received at least one unit of homologous blood. In the control group, 43% of the patients received at least one unit of blood in the OR or in the ICU and there was a stastistically-significant 38% reduction in homologous blood product use (p = 0.05). For the patients who received homologous blood, there was also a significant reduction in transfused volume (0.53 +/- 0.90 units blood mini bypass vs 1.3 +/- 1.93 units conventional, p < 0.05). In terms of FFP, there was also a stastistically significant difference between the two groups (0 units transfused in mini bypass group vs 3 patients receiving one unit FFP in the control group, p < 0.001). Cumulative postoperative bleeding during the ICU stay was also evaluated, yielding a significant reduction (365 +/- 495 ml mini bypass vs 825 +/- 975 ml conventional, p < 0.05).
Mini bypass reduces on-pump hemodilution and, therefore, donor blood usage in routine CABG patients as compared to conventional ECC circuits and can reduce postoperative bleeding as compared to a traditional system. The mini bypass system is safe in routine clinical use and can manage easily the same number of anastomoses as a traditional system and should be considered a favorable alternative to conventional ECC in all revascularization cases.
本研究的目的是调查以下假设，即简化的体外循环（ECC）系统及随之而来的患者血液稀释度降低会影响血液制品的使用。
我们对一组连续60例冠状动脉旁路移植术（CABG）患者进行了一项前瞻性随机研究，比较了30个小型旁路系统（n = 30）与30个传统系统（n = 30）的血液制品使用情况和术后出血情况。患者的人口统计学数据，包括体重、身高、年龄、术前血红蛋白、术前血细胞比容、体表面积、射血分数和纽约心脏协会（NYHA）分级，差异无统计学意义。
通过手术室并持续追踪至重症监护病房，记录血液制品的使用情况，包括新鲜冰冻血浆（FFP）和异体输血。在小型旁路组中，虽然手术室中未进行异体输血，但27%的患者接受了至少1单位的异体血。在对照组中，43%的患者在手术室或重症监护病房接受了至少1单位的血液，异体血液制品的使用量显著减少了38%（p = 0.05）。对于接受异体输血的患者，输血量也显著减少（小型旁路组为0.53±0.90单位血液，传统组为1.3±1.93单位，p < 0.05）。在FFP方面，两组之间也存在统计学显著差异（小型旁路组未输血，对照组有3例患者接受了1单位FFP，p < 0.001）。还评估了重症监护病房住院期间的累计术后出血量，结果显示显著减少（小型旁路组为365±495 ml，传统组为825±975 ml，p < 0.05）。
与传统的ECC回路相比，小型旁路可减少常规CABG患者的体外循环血液稀释，从而减少供体血液的使用，并且与传统系统相比可减少术后出血。小型旁路系统在常规临床使用中是安全的，能够轻松处理与传统系统相同数量的吻合口，在所有血运重建病例中应被视为传统ECC的有利替代方案。
