Rubens Fraser D, Boodhwani Munir, Mesana Thierry, Wozny Denise, Wells George, Nathan Howard J
Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Circulation. 2007 Sep 11;116(11 Suppl):I89-97. doi: 10.1161/CIRCULATIONAHA.106.678987.
Reinfusion of unprocessed cardiotomy blood during cardiac surgery can introduce particulate material into the cardiopulmonary bypass circuit, which may contribute to postoperative cognitive dysfunction. On the other hand, processing of this blood by centrifugation and filtration removes coagulation factors and may potentially contribute to coagulopathy. We sought to evaluate the effects of cardiotomy blood processing on blood product use and neurocognitive functioning after cardiac surgery.
Patients undergoing coronary and/or aortic valve surgery using cardiopulmonary bypass were randomized to receive unprocessed blood (control, n=134) or cardiotomy blood that had been processed by centrifugal washing and lipid filtration (treatment, n=132). Patients and treating physicians were blinded to treatment assignment. A strict transfusion protocol was followed. Blood transfusion data were analyzed using Poisson regression models. The treatment group received more intraoperative red blood cell transfusions (0.23+/-0.69 U versus 0.08+/-0.34 U, P=0.004). Both red blood cell and nonred blood cell blood product use was greater in the treatment group and postoperative bleeding was greater in the treatment group. Patients were monitored intraoperatively by transcranial Doppler and they underwent neuropsychometric testing before surgery and at 5 days and 3 months after surgery. There was no difference in the incidence of postoperative cognitive dysfunction in the 2 groups (relative risk: 1.16, 95% CI: 0.86 to 1.57 at 5 days postoperatively; relative risk: 1.05, 95% CI: 0.58 to 1.90 at 3 months). There was no difference in the quality of life nor was there a difference in the number of emboli detected in the 2 groups.
Contrary to expectations, processing of cardiotomy blood before reinfusion results in greater blood product use with greater postoperative bleeding in patients undergoing cardiac surgery. There is no clinical evidence of any neurologic benefit with this approach in terms of postoperative cognitive function.
心脏手术期间回输未处理的心脏切开术血液可将颗粒物质引入体外循环回路，这可能导致术后认知功能障碍。另一方面，通过离心和过滤处理这种血液会去除凝血因子，并可能导致凝血功能障碍。我们试图评估心脏切开术血液处理对心脏手术后血液制品使用和神经认知功能的影响。
接受体外循环冠状动脉和/或主动脉瓣手术的患者被随机分为接受未处理血液组（对照组，n = 134）或经离心洗涤和脂质过滤处理的心脏切开术血液组（治疗组，n = 132）。患者和治疗医生对治疗分配不知情。遵循严格的输血方案。使用泊松回归模型分析输血数据。治疗组术中接受更多红细胞输血（0.23±0.69单位对0.08±0.34单位，P = 0.004）。治疗组红细胞和非红细胞血液制品的使用均更多，且治疗组术后出血更多。术中通过经颅多普勒对患者进行监测，他们在手术前、术后5天和3个月接受神经心理测试。两组术后认知功能障碍的发生率无差异（术后5天相对风险：1.16，95%可信区间：0.86至1.57；术后3个月相对风险：1.05，95%可信区间：0.58至1.90）。两组的生活质量无差异，检测到的栓子数量也无差异。
与预期相反，心脏切开术血液在回输前进行处理会导致心脏手术患者更多地使用血液制品且术后出血更多。就术后认知功能而言，这种方法没有任何神经学益处的临床证据。
