Saxena Pravin, Saxena Nita, Jain Ashu, Sharma Vipul Krishen
Department of Cardiac Anaesthesia, AIIMS, New Delhi, India.
Ann Card Anaesth. 2003 Jan;6(1):47-51.
Haemodilution resulting from crystalloid priming of the cardiopulmonary bypass (CPB) circuit is one of the important reasons for blood transfusion in cardiac surgery, especially in patients with low body surface area (BSA). A prospective study was performed to investigate the technique of intraoperative blood donation (IAD) and retrograde autologous priming (RAP) to limit haemodilution and transfusion requirements. Forty patients with low BSA (<1.7 m2) undergoing primary valvular cardiac surgery were assigned to either RAP group or a control group (C). The RAP group (n=20) was subjected to IAD by collecting a calculated volume of blood (272+/-44.3 mL) after induction of anaesthesia. Prior to initiation of CPB the prime volume was reduced by discarding some of it and the CPB reservoir was filled retrogradely through the aortic cannula draining 482+/-78.4 mL of blood. In group C (n=20) only IAD was carried out collecting 295.0+/-62.6 mL of blood. Anaesthetic technique was similar in both groups. Strict transfusion thresholds were observed. There were no significant difference between the groups with respect to baseline characteristics, BSA, type of procedure, perfusion technique and haematologic profile. The haematocrit on CPB was significantly higher in the RAP group as compared with group C (24.2+/-1.3% and 22.1+/-2.5% respectively, p=0.009). Transfusion of allogenic blood during and after surgery was significantly lower in the RAP group (143.6+/-117 mL) versus 405.2+/-358.1 mL in group C (p=0.02). Postoperative chest tube drainage was 218+/-67.4 mL in the RAP group and 300+/-191 mL in group C which was not significantly different (p=0.18). The technique of intraoperative autologous donation and retrograde priming is simple, safe and cost effective procedure for blood conservation in patients with small BSA undergoing primary valvular surgery.
体外循环（CPB）回路晶体预充导致的血液稀释是心脏手术中输血的重要原因之一，尤其是在体表面积（BSA）较低的患者中。进行了一项前瞻性研究，以调查术中自体献血（IAD）和逆行自体预充（RAP）技术，以限制血液稀释和输血需求。40例接受初次瓣膜心脏手术且BSA较低（<1.7 m2）的患者被分为RAP组或对照组（C）。RAP组（n = 20）在麻醉诱导后通过采集计算量的血液（272±44.3 mL）进行IAD。在CPB开始前，通过丢弃部分预充液减少预充量，并通过主动脉插管逆行向CPB储血器中注入482±78.4 mL血液。C组（n = 20）仅进行IAD，采集295.0±62.6 mL血液。两组的麻醉技术相似。均遵循严格的输血阈值。两组在基线特征、BSA、手术类型、灌注技术和血液学指标方面无显著差异。与C组相比，RAP组CPB期间的血细胞比容显著更高（分别为24.2±1.3%和22.1±2.5%，p = 0.009）。RAP组手术期间和术后异体血的输血量显著低于C组（143.6±117 mL），而C组为405.2±358.1 mL（p = 0.02）。RAP组术后胸管引流量为218±67.4 mL，C组为300±191 mL，差异无统计学意义（p = 0.18）。术中自体献血和逆行预充技术对于接受初次瓣膜手术且BSA较小的患者来说，是一种简单、安全且具有成本效益的血液保护方法。
