Whitson Bryan A, Huddleston Stephen J, Savik Kay, Shumway Sara J
Department of Surgery, Division of Cardiovascular and Thoracic Surgery, University of Minnesota, Minneapolis, Minnesota 55455, USA.
J Card Surg. 2007 Sep-Oct;22(5):373-8. doi: 10.1111/j.1540-8191.2007.00428.x.
Blood transfusion with cardiac surgery accounts for 20% of transfusions in the United States. The effect of perioperative transfusion on cardiac surgery outcomes is unknown. We hypothesized that cardiac surgery with perioperative blood transfusion was associated with worse outcomes.
A prospectively maintained (Society of Thoracic Surgeons) institutional database was analyzed from 2000 to 2005. All patients undergoing coronary artery bypass and/or valve operations were evaluated for the association of preoperative and intraoperative risk factors with blood transfusion. The association of transfusion with postoperative complications and mortality was evaluated.
During the study period, 2691 patients met inclusion criteria. Sixty-four percent received transfusions. Preoperative risk factors associated with transfusion (p < 0.05) were lung disease, elevated creatinine, peripheral vascular disease, and previous cardiac interventions. Patients requiring transfusion were older (mean 65.2 vs. 61.2 years, p < 0.001). Transfusion was associated with longer cross-clamp (median 78 vs. 88 minutes, p < 0.001) and perfusion times (median 114 vs. 128 minutes, p < 0.001). Perioperative blood transfusion was associated with increased postoperative complications (53.5% vs. 30.5%, p < 0.001). Significant transfusion-associated complications were renal failure, prolonged ventilation time, pneumonia, cardiac arrest, gastrointestinal complications, atrial fibrillation, stroke, myocardial infarction, and bleeding requiring reoperation. Blood transfusion was associated with an increased operative mortality (3.4% vs. 1.7%, p = 0.005) and length of stay after surgery (median 6 vs. 5 days p < 0.001).
Identification and management of risk factors associated with transfusion may reduce the transfusion requirement, minimize perioperative complications and improve outcomes. Bloodless cardiac surgery is associated with a decreased morbidity and mortality.
在美国，心脏手术输血占输血总量的20%。围手术期输血对心脏手术结局的影响尚不清楚。我们假设围手术期输血的心脏手术与更差的结局相关。
对2000年至2005年前瞻性维护的（胸外科医师协会）机构数据库进行分析。对所有接受冠状动脉搭桥和/或瓣膜手术的患者评估术前和术中危险因素与输血的关联。评估输血与术后并发症及死亡率的关联。
在研究期间，2691例患者符合纳入标准。64%的患者接受了输血。与输血相关的术前危险因素（p<0.05）有肺部疾病、肌酐升高、外周血管疾病和既往心脏干预。需要输血的患者年龄更大（平均65.2岁对61.2岁，p<0.001）。输血与更长的主动脉阻断时间（中位数78分钟对88分钟，p<0.001）和灌注时间（中位数114分钟对128分钟，p<0.001）相关。围手术期输血与术后并发症增加相关（53.5%对30.5%，p<0.001）。与输血相关的显著并发症有肾衰竭、通气时间延长、肺炎、心脏骤停、胃肠道并发症、心房颤动、中风、心肌梗死以及需要再次手术的出血。输血与手术死亡率增加（3.4%对1.7%，p=0.005）和术后住院时间延长（中位数6天对5天，p<0.001）相关。
识别和管理与输血相关的危险因素可能会减少输血需求，将围手术期并发症降至最低并改善结局。非输血心脏手术与发病率和死亡率降低相关。
