Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, The Netherlands.
Transfusion. 2012 Jan;52(1):82-90. doi: 10.1111/j.1537-2995.2011.03231.x. Epub 2011 Jul 11.
There is an association between blood transfusion and pulmonary complications in cardiac surgery. Mediators of increased pulmonary vascular leakage after transfusion are unknown. We hypothesized that factors may include antibodies or bioactive lipids, which have been implicated in transfusion-related acute lung injury.
We performed a prospective cohort study in two university hospital intensive care units in the Netherlands. Pulmonary vascular permeability was measured in cardiac surgery patients after receiving no, restrictive (one or two transfusions), or multiple (five or more transfusions) transfusions (n=20 per group). The pulmonary leak index (PLI), using (67) Ga-labeled transferrin, was determined within 3 hours postoperatively. Blood products were screened for bioactive lipid accumulation and the presence of antibodies.
The PLI was elevated in all groups after cardiac surgery. Transfused patients had a higher PLI compared to nontransfused patients (33×10(-3) ± 20×10(-3) vs. 23×10(-3) ± 11×10(-3)/min, p<0.01). The amount of red blood cell (RBC) products, but not of fresh-frozen plasma or platelets, was associated with an increase in PLI (β, 1.6 [0.2-3.0]). Concerning causative factors in the blood product, neither the level of bioactive lipids nor the presence of antibodies was associated with an increase in PLI. Patient factors such as surgery risk and time on cardiopulmonary bypass did not influence the risk of pulmonary leakage after blood transfusion.
Transfusion in cardiothoracic surgery patients is associated with an increase in pulmonary capillary permeability, an effect that was dose dependent for RBC products. The level of bioactive lipids or the presence of HLA or HNA antibodies in the transfused products were not associated with increased pulmonary capillary permeability.
输血与心脏手术中的肺部并发症之间存在关联。输血后肺血管通透性增加的介质尚不清楚。我们假设，这些因素可能包括抗体或生物活性脂质，这些物质与输血相关的急性肺损伤有关。
我们在荷兰的两家大学医院重症监护病房进行了一项前瞻性队列研究。在接受无输血、限制输血（一次或两次输血）或多次输血（每组 20 例）的心脏手术患者中，测量术后 3 小时内的肺血管通透性。使用（67）Ga 标记的转铁蛋白测定肺漏指数（PLI）。筛选血液制品中生物活性脂质的积累和抗体的存在。
心脏手术后所有组的 PLI 均升高。与未输血的患者相比，输血的患者的 PLI 更高（33×10（-3）±20×10（-3）与 23×10（-3）±11×10（-3）/min，p<0.01）。红细胞（RBC）制品的数量，而不是新鲜冷冻血浆或血小板的数量，与 PLI 的增加相关（β，1.6[0.2-3.0]）。关于血液制品中的因果因素，生物活性脂质的水平或抗体的存在均与 PLI 的增加无关。患者因素，如手术风险和体外循环时间，并不影响输血后发生肺泄漏的风险。
在心胸外科手术患者中输血与肺毛细血管通透性增加相关，该效应与 RBC 制品的剂量呈依赖性。输注产品中的生物活性脂质水平或 HLA 或 HNA 抗体的存在与肺毛细血管通透性增加无关。
