Vretzakis G, Kleitsaki A, Stamoulis K, Dragoumanis C, Tasoudis V, Kyriakaki K, Mikroulis D, Giannoukas A, Tsilimingas N
Cardiac Anesthesia Unit, Department of Anesthesiology, University Hospital of Larissa, Greece.
Acta Anaesthesiol Belg. 2009;60(4):221-8.
Hemodilution contributes significantly to transfusion requirements in patients undergoing CABG under CPB. We hypothesised that restriction of parenteral fluids in comparison to a liberal fluid administration policy leads to less use of packed red cells in CABG operations supported by cell salvage. After consent and approval, 130 patients operated under equal conditions were assigned prospectively and randomly either for a restrictive protocol for intravenous fluid administration (group A, 65 pts) or not (group B, 65 pts). Transfusion guidelines were common for the two groups. The volumes of intravenous fluids, priming, "extra" volume on pump and cardioplegic solution and the volume of urine were recorded. Net erythrocyte volume loss was calculated. The number of the transfused PRC was analyzed as a continuous variable. "Transfusion" was analyzed as a categorical characteristic. Significant difference existed between groups for the fluids administered intravenously until the initiation of CPB and for fluid balance after CPB. Intraoperatively transfused units were significantly lower in A (0.32 +/- 0.77 vs 1.26 +/- 1.05 u/per pt; p<0.0001). Transfused patients were also significantly lower in A (11/65 vs 44/65; p<0.0001). In both groups, the values of hematocrit were statistically decreased. The greatest difference compared to the preoperative values was observed after CPB (from 40.8 +/- 4.2 to 21.9 +/- 3.6 for A, and from 40.2 +/- 3.7 to 19.7 +/- 3.3 for B ; p<0.0001 for both). For these lowest values, significant difference existed between groups (p<0,001) while the difference in the hematocrit values to the end of operation was insignificant. Transfusion in ICU showed no significant difference among groups. Hours of mechanical ventilation in ICU were ranging from 5 to 29 (mean = 10.0, median = 9) for A and from 5 to 42 (mean = 14.8, median = 10) for B. Length of stay in ICU in nights for group A was ranging from 1 to 10 (mean = 2.7, median = 2) and for group B was ranging from 1 to 6 (mean = 3.5, median = 2). In conclusion, reduction of transfusions in CABG operations is feasible when a restrictive protocol for intravenous fluids is applied.
在体外循环下进行冠状动脉旁路移植术（CABG）的患者中，血液稀释对输血需求有显著影响。我们假设，与宽松的液体管理策略相比，限制肠外补液可减少在细胞回收支持的CABG手术中浓缩红细胞的使用。在获得同意并获批后，130例在相同条件下接受手术的患者被前瞻性地随机分为两组，一组采用静脉补液限制方案（A组，65例患者），另一组不采用（B组，65例患者）。两组的输血指南相同。记录静脉补液量、预充量、体外循环时的“额外”补液量、心脏停搏液量和尿量。计算红细胞净丢失量。将输注的浓缩红细胞数量作为连续变量进行分析。将“输血”作为分类特征进行分析。在开始体外循环前静脉输注的液体量以及体外循环后的液体平衡方面，两组之间存在显著差异。术中A组输注的单位数显著低于B组（0.32±0.77单位/每例患者对1.26±1.05单位/每例患者；p<0.0001）。A组接受输血的患者也显著少于B组（11/65对44/65；p<0.0001）。两组的血细胞比容值均有统计学意义的下降。与术前值相比，最大差异出现在体外循环后（A组从40.8±4.2降至21.9±3.6，B组从40.2±3.7降至19.7±3.3；两组p均<0.0001）。对于这些最低值，两组之间存在显著差异（p<0.001），而到手术结束时血细胞比容值的差异不显著。重症监护病房（ICU）中的输血情况在两组之间无显著差异。A组在ICU的机械通气时间为5至29小时（平均 = 10.0，中位数 = 9），B组为5至42小时（平均 = 14.8，中位数 = 10）。A组在ICU的住院天数为1至10天（平均 = 2.7，中位数 = 2），B组为1至6天（平均 = 3.5，中位数 = 2）。总之，在CABG手术中应用静脉补液限制方案时，减少输血是可行的。
