Campbell Jeffrey A, Holt David W, Shostrom Valerie K, Durham Samuel J
University of Toledo Medical Center, Toledo, Ohio 43614, USA.
J Extra Corpor Technol. 2008 Jun;40(2):99-108.
A hematocrit (Hct) of less than 25% during cardiopulmonary bypass (CPB) and transfusion of homologous packed red blood cells (PRBC) are each associated with an increased probability of adverse events in cardiac surgery. Although the CPB circuit is a major contributor to hemodilution intravenous (IV) fluid volume may also significantly influence the level of hemodilution. The objective of this study was to explore the influence of asanguinous IV fluid volume on CPB Hct and intraoperative PRBC transfusion. After Institutional Review Board approval, a retrospective chart review of 90 adult patients that had undergone an elective, isolated CABG with CPB was conducted. Regression analysis was used to determine if pre-CPB fluid volume was associated with the lowest CPB Hct and the incidence of an intraoperative PRBC transfusion. In separate multivariate analyses, higher pre-CPB fluid volume was associated with lower minimum CPB Hct (p < .0001), and higher minimum CPB Hct was associated with a decreased probability of PRBC transfusion (p < .0001). Compared to patients that received <1600 mL (n = 55) of pre-CPB fluid, those that received >1600 mL (n = 35) had a decreased mean low CPB Hct (22.4% vs 25.6%, p < .0001), an increased incidence of a CPB Hct <25% (74% vs. 38%, p = .0008) and PRBC transfusion (60% vs. 16%, p < .0001), and increased median PRBC units transfused (2.0 vs 1.0, p = .1446) despite no significant difference in gender, age, patient size, baseline Hct, or CPB prime volume. Patients that received a PRBC transfusion (n = 30) received a significantly higher volume of pre-CPB fluid than nontransfused patients (1800 vs. 1350 mL, p = .0039). These findings suggest that pre-CPB fluid volume can significantly contribute to hemodilutional anemia in cardiac surgery. Optimizing pre-CPB volume may preserve baseline Hct and help limit intraoperative hemodilution.
在体外循环（CPB）期间，血细胞比容（Hct）低于25%以及输注异体浓缩红细胞（PRBC）均与心脏手术中不良事件发生概率的增加相关。尽管CPB回路是导致血液稀释的主要因素，但静脉（IV）输液量也可能显著影响血液稀释水平。本研究的目的是探讨无血IV输液量对CPB期间Hct及术中PRBC输注的影响。经机构审查委员会批准后，对90例接受择期、单纯CPB下冠状动脉旁路移植术（CABG）的成年患者进行了回顾性病历审查。采用回归分析来确定CPB前的输液量是否与最低CPB Hct及术中PRBC输注发生率相关。在单独的多变量分析中，较高的CPB前输液量与较低的最低CPB Hct相关（p <.0001），而较高的最低CPB Hct与PRBC输注概率降低相关（p <.0001）。与接受CPB前输液量<1600 mL（n = 55）的患者相比，接受>1600 mL（n = 35）的患者平均最低CPB Hct降低（22.4%对25.6%，p <.0001），CPB Hct<25%的发生率增加（74%对38%，p =.0008）以及PRBC输注发生率增加（60%对16%，p <.0001），且输注PRBC的中位数单位增加（2.0对1.0，p =.1446），尽管在性别、年龄、患者体型、基线Hct或CPB预充量方面无显著差异。接受PRBC输注的患者（n = 30）CPB前输液量显著高于未输注患者（1800对1350 mL，p =.0039）。这些发现表明，CPB前输液量可显著导致心脏手术中的稀释性贫血。优化CPB前输液量可能维持基线Hct并有助于限制术中血液稀释。
