Manno C S, Hedberg K W, Kim H C, Bunin G R, Nicolson S, Jobes D, Schwartz E, Norwood W I
Clinical Laboratories, Children's Hospital of Philadelphia, PA 19104.
Blood. 1991 Mar 1;77(5):930-6.
In a double-blind study, we compared the postoperative (post-op) blood loss in 161 children undergoing open heart surgery with cardiopulmonary bypass whose immediate post-op transfusion requirements were met with either very fresh whole blood (VFWB), 24- to 48-hour-old whole blood or reconstituted whole blood (packed red blood cells, fresh frozen plasma [FFP], and platelets). Assignment to treatment groups was not strictly random but dependent, in part, on the ability of families to provide directed donors for fresh blood. The three patient groups were comparable with respect to patient age, pre-op coagulation profiles (bleeding time, prothrombin time, activated partial thromboplastin time, platelet count, fibrin split products, fibrinogen, and platelet aggregation tests) difficulty of operative procedures and time spent on CPB. Mean 24-hour post-op blood loss in milliliters per kilogram was 50.9 +/- 9.3 in the VFWB group, 44.8 +/- 6.0 in the 24- to 48-hour-old group, and 74.2 +/- 8.9 in the reconstituted group (p = .03). When blood loss was compared in the 93 children less than 2 years of age, mean blood loss was 52.3 +/- 10.8 in the VFWB group, 51.7 +/- 7.4 in the 24- to 48-hour-old group, and 96.2 +/- 10.7 in the reconstituted group (P = .001). For subjects who had received reconstituted blood, 30-minute and 3-hour post-op platelet aggregation responses to adenosine diphosphate (10 mumol/L) and 30-minute aggregation response to epinephrine (2.5 mumol/L) were more depressed than in the VFWB and 24- to 48-hour groups (P less than .001, P = .005, and P = .02). Comparison of other post-op coagulation tests could not explain the increased blood loss in the reconstituted group. We conclude that the transfusion of less than 48 hours old whole blood is associated with significantly less post-op blood loss than the transfusion of packed red blood cells, FFP, and platelets in children under 2 years old who underwent complex cardiac surgery. The blood losses associated with the transfusion of VFWB and 24- to 48-hour-old blood are comparable and may be, in part, due to better functioning platelets.
在一项双盲研究中，我们比较了161名接受体外循环心脏直视手术的儿童术后失血情况，这些儿童术后立即输血需求通过输注极新鲜全血（VFWB）、24至48小时龄全血或重组全血（浓缩红细胞、新鲜冰冻血浆[FFP]和血小板）来满足。治疗组的分配并非严格随机，部分取决于家庭提供新鲜血液定向献血者的能力。三组患者在患者年龄、术前凝血指标（出血时间、凝血酶原时间、活化部分凝血活酶时间、血小板计数、纤维蛋白降解产物、纤维蛋白原和血小板聚集试验）、手术操作难度以及体外循环时间方面具有可比性。VFWB组术后24小时每千克平均失血量为50.9±9.3毫升，24至48小时龄组为44.8±6.0毫升，重组组为74.2±8.9毫升（p = 0.03）。在93名2岁以下儿童中比较失血量时，VFWB组平均失血量为52.3±10.8毫升，24至48小时龄组为51.7±7.4毫升，重组组为96.2±10.7毫升（P = 0.001）。对于接受重组血液的受试者，术后30分钟和3小时对二磷酸腺苷（10μmol/L）的血小板聚集反应以及对肾上腺素（2.5μmol/L）的30分钟聚集反应比VFWB组和24至48小时龄组更受抑制（P＜0.001，P = 0.005，P = 0.02）。其他术后凝血试验的比较无法解释重组组失血量增加的原因。我们得出结论，对于接受复杂心脏手术的2岁以下儿童，输注年龄小于48小时的全血与术后失血量显著少于输注浓缩红细胞、FFP和血小板相关。输注VFWB和24至48小时龄血液的失血量相当，部分原因可能是血小板功能更好。
