Pediatric Division of Cardiology, UCSF Children's Hospital, and Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA.
Pediatr Crit Care Med. 2011 Jan;12(1):52-6. doi: 10.1097/PCC.0b013e3181e30d43.
Perioperative transfusion has adverse effects in adults undergoing cardiac surgery. We sought to investigate whether greater use of blood and blood products might be an independent predictor of prolonged postoperative recovery, indicated by duration of mechanical ventilation (DMV), after reparative infant heart surgery.
Secondary analysis of prospectively collected data from two randomized trials of hematocrit strategy during cardiopulmonary bypass in infant heart surgery to explore the association of DMV with perioperative transfusion and other variables.
Tertiary pediatric hospital.
Two hundred seventy infants undergoing two ventricle corrective cardiac surgery without aortic arch reconstruction.
In univariable analyses, longer DMV was associated with younger age and lower weight at surgery, diagnostic group, and higher intraoperative and postoperative blood product transfusion (each p < .001). In multivariable proportional hazard regression, longer total support time and greater intraoperative and early postoperative blood products per kg were the strongest predictors of longer DMV. Patients in the highest tertile of intraoperative blood products per kg had an instantaneous risk of being extubated approximately half that of patients in the lowest tertile (hazard ratio, 0.51; 95% confidence interval, 0.35, 0.73). Patients who received any blood products on postoperative day 1, compared with those who did not, had a hazard ratio for extubation of 0.65 (95% confidence interval, 0.50, 0.85).
In this exploratory secondary analysis of infants undergoing two ventricular repair of congenital heart disease without aortic arch obstruction, greater intraoperative and early postoperative blood transfusion emerged as potential important risk factors for longer DMV. Future prospective clinical trials are needed to determine whether reduction in blood product administration hastens postoperative recovery after infant heart surgery.
围手术期输血会对接受心脏手术的成年人产生不良影响。我们试图研究在修复婴儿心脏手术中，是否更多地使用血液和血液制品可能是术后机械通气时间（DMV）延长的独立预测因素，而 DMV 延长表示术后恢复时间延长。
对婴儿心脏手术体外循环中红细胞压积策略的两项随机试验中前瞻性收集数据的二次分析，以探讨 DMV 与围手术期输血和其他变量的关系。
三级儿科医院。
270 名接受双心室矫正心脏手术而不进行主动脉弓重建的婴儿。
在单变量分析中，DMV 延长与年龄较小、手术时体重较轻、诊断组、术中及术后血液制品输注量较高有关（均 p <.001）。在多变量比例风险回归中，总支持时间较长和术中及早期术后每公斤血液制品输注量较多是 DMV 延长的最强预测因素。术中每公斤血液制品输注量最高 tertile 的患者拔管的即时风险约为最低 tertile 的一半（危险比，0.51；95%置信区间，0.35，0.73）。与未接受血液制品的患者相比，术后第 1 天接受任何血液制品的患者拔管的危险比为 0.65（95%置信区间，0.50，0.85）。
在这项对不伴有主动脉弓阻塞的先天性心脏病双心室修复的婴儿进行的探索性二次分析中，术中及早期术后输血量增加被认为是 DMV 延长的潜在重要危险因素。需要前瞻性临床试验来确定减少血液制品的使用是否能加速婴儿心脏手术后的术后恢复。
