Calcaterra D, Ricci M, Lombardi P, Katariya K, Panos A, Salerno T A
Department of Cardiothoracic Surgery, University of Iowa Carver College of Medicine, Iowa City, IA 52242-1062, USA.
J Cardiovasc Surg (Torino). 2009 Dec;50(6):813-7.
Hypothermia has been used for decades in cardiac surgery to limit the ischemic insult to the heart. With the diffusion of off-pump coronary artery surgery, the practice of arresting and cooling the heart has been abandoned. At University of Miami Miller School of Medicine, we tested a new warming device by performing a prospective study in which 50 patients were randomized to either the use of the Kimberly-Clark warming system or to standard methods of control of body temperature. The two groups were compared in terms of core body temperature (CBT), intra- and postoperative blood loss, blood products transfusions, extubation time, intensive care unit (ICU) and hospital length of stay and incidence of infections. Five patients in the control group and 0 patients in the study group dropped their CBT below 35 degrees C during the operation (P<0.01). Total blood loss, measured in terms of cell-saver and chest tube drainage, was 27 % and 14 % less for the study group (P<0.01). Hospital length of stay was 1.2 day less in the study group (P<0.01). The Kimberly-Clark Patient Warming System allowed for better control of core body temperature during off pump coronary artery bypass surgery compared to traditional techniques. This translated in less intra and postoperative blood loss and shorter hospital length of stay. Other advantages, such as decreased blood-products transfusions, decreased incidence of infections, decreased ICU length of stay and overall reduction of costs might be evident on larger study groups.
几十年来，低温技术一直应用于心脏手术中，以限制心脏的缺血性损伤。随着非体外循环冠状动脉手术的普及，心脏停跳和降温的做法已被摒弃。在迈阿密大学米勒医学院，我们进行了一项前瞻性研究，测试了一种新型保暖装置，将50名患者随机分为两组，一组使用金佰利保暖系统，另一组采用标准体温控制方法。对两组患者的核心体温（CBT）、术中和术后失血量、血液制品输注量、拔管时间、重症监护病房（ICU）住院时间、医院住院时间以及感染发生率进行了比较。对照组有5名患者，研究组有0名患者在手术过程中核心体温降至35摄氏度以下（P<0.01）。以细胞回收器和胸管引流量衡量的总失血量，研究组比对照组分别减少了27%和14%（P<0.01）。研究组的医院住院时间缩短了1.2天（P<0.01）。与传统技术相比，金佰利患者保暖系统在非体外循环冠状动脉搭桥手术中能更好地控制核心体温。这意味着术中和术后失血量减少，医院住院时间缩短。在更大规模的研究组中，可能还会明显体现出其他优势，如减少血液制品输注量﹑降低感染发生率、缩短ICU住院时间以及总体成本降低等。
