Karlsson Martin, Ternström Lisa, Hyllner Monica, Baghaei Fariba, Nilsson Staffan, Jeppsson Anders
Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
Transfusion. 2008 Oct;48(10):2152-8. doi: 10.1111/j.1537-2995.2008.01827.x. Epub 2008 Jul 24.
Early identification of patients with increased risk of excessive bleeding and transfusion after cardiac surgery offers the possibility to initiate countermeasures. Fibrinogen is a key protein in the coagulation cascade and thus a potential biomarker for bleeding. We investigated the relationship between preoperative fibrinogen plasma concentration and postoperative bleeding and transfusion after coronary artery bypass grafting (CABG).
A total of 170 patients (mean age, 67 +/- 9 years; 75% men) undergoing isolated CABG were included in a prospective observational study. Patient variables (age, sex, operation time, anticoagulation therapy), preoperative laboratory variables (platelet [PLT] count, activated partial thromboplastin time, prothrombin time, and fibrinogen), postoperative bleeding volume, and transfusions during hospital stay were registered. Independent predictors of bleeding volume and transfusion were identified with multiple regression models.
Postoperative bleeding volume correlated univariately with preoperative fibrinogen concentration (r = -0.53, p < 0.001) and PLT count (r = -0.26, p = 0.001) but only preoperative fibrinogen concentration was an independent predictor of postoperative bleeding volume. Twenty-nine of the 170 patients (17%) received transfusions with blood products. Independent predictors of transfusion were preoperative fibrinogen concentration (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.1-3.7 per 1-unit decrease; p = 0.027), female sex (OR, 5.0; 95% CI, 1.8-14.7; p = 0.002), and aortic cross-clamp time (OR, 1.03; 95% CI, 1.01-1.06 per minute; p = 0.013).
The results indicate that preoperative fibrinogen concentration (even within the normal range) is a limiting factor for postoperative hemostasis. Preoperative measurement of fibrinogen concentration provides information about bleeding volume and transfusion requirements after CABG.
早期识别心脏手术后出血和输血风险增加的患者为采取应对措施提供了可能。纤维蛋白原是凝血级联反应中的关键蛋白，因此是出血的潜在生物标志物。我们研究了冠状动脉旁路移植术（CABG）术前纤维蛋白原血浆浓度与术后出血及输血之间的关系。
一项前瞻性观察性研究纳入了170例行单纯CABG的患者（平均年龄67±9岁；75%为男性）。记录患者变量（年龄、性别、手术时间、抗凝治疗）、术前实验室变量（血小板[PLT]计数、活化部分凝血活酶时间、凝血酶原时间和纤维蛋白原）、术后出血量以及住院期间的输血情况。采用多元回归模型确定出血量和输血的独立预测因素。
术后出血量与术前纤维蛋白原浓度（r = -0.53，p < 0.001）和PLT计数（r = -0.26，p = 0.001）单因素相关，但只有术前纤维蛋白原浓度是术后出血量的独立预测因素。170例患者中有29例（17%）接受了血液制品输血。输血的独立预测因素为术前纤维蛋白原浓度（比值比[OR]，2.0；95%置信区间[CI]，每降低1个单位为1.1 - 3.7；p = 0.027）、女性（OR，5.0；95% CI，1.8 - 14.7；p = 0.002）和主动脉阻断时间（OR，1.03；95% CI，每分钟为1.01 - 1.06；p = 0.013）。
结果表明术前纤维蛋白原浓度（即使在正常范围内）是术后止血的限制因素。术前测量纤维蛋白原浓度可提供CABG术后出血量和输血需求的信息。
