Grist Gary, Whittaker Carrie, Merrigan Kellie, Fenton Jason, Worrall Elizabeth, O'Brien James, Lofland Gary
Section of Cardiovascular Surgery, The Children's Mercy Hospitals and Clinics, Kansas City, Missouri 64108, USA.
J Extra Corpor Technol. 2011 Dec;43(4):215-26.
Edema acquired during the perioperative period has long been associated with increased mortality. Edema acquired during cardiopulmonary bypass (CPB) may contribute to this mortality. The intent of this retrospective study was to test the premise that edema in the form of a positive fluid balance change (FBC) acquired during CPB correlated to mortality. If so, FBC from the beginning of CPB (baseline; FBC = 0) to the end of CPB may need to be monitored, measured, and controlled on CPB with the same ardor as blood pressure and pH. This retrospective analysis reviewed the FBC of 1540 pediatric and congenital heart surgery patients at the end of CPB. Additions and subtractions of fluid to the combined patient/CPB circuit were routinely quantified during CPB procedures and during periods of modified ultrafiltration (MUF). The primary outcome assessed was mortality during hospitalization. The overall mortality of the 1540 patients was 5.65% from all causes. Eighty percent (n = 1226, mortality = 4.65%) of the patients had a zero or negative FBC immediately after CPB/MUF. Twenty percent (n = 314, mortality = 9.55%) had a positive FBC. Positive FBC patients tended to be in higher risk categories, weighed more, and had longer pump times (p < .05) with an adjusted odds ratio for mortality of 1.73 (1.01-2.96, 95% confidence interval). There is a correlation between edema acquired during CPB and increased mortality in pediatric and congenital heart surgery patients. The potential exists for the perfusionist to optimize the fluid balance changes while on CPB to reduce mortality rates.
围手术期获得性水肿长期以来一直与死亡率增加相关。体外循环（CPB）期间获得性水肿可能是导致这种死亡率升高的原因之一。本回顾性研究的目的是检验这样一个前提，即CPB期间以正性液体平衡变化（FBC）形式出现的水肿与死亡率相关。如果是这样，那么从CPB开始（基线；FBC = 0）到CPB结束时的FBC可能需要像监测、测量和控制血压及pH值一样，在CPB期间受到同等程度的密切关注。这项回顾性分析评估了1540例小儿及先天性心脏病手术患者在CPB结束时的FBC。在CPB手术期间及改良超滤（MUF）期间，常规对患者与CPB循环系统中的液体出入量进行量化。评估的主要结局是住院期间的死亡率。这1540例患者的全因总死亡率为5.65%。80%（n = 1226，死亡率 = 4.65%）的患者在CPB/MUF后即刻FBC为零或负值。20%（n = 314，死亡率 = 9.55%）的患者FBC为正值。FBC为正值的患者往往属于更高风险类别，体重更重，体外循环时间更长（p < 0.05），调整后的死亡比值比为1.73（1.01 - 2.96，95%置信区间）。在小儿及先天性心脏病手术患者中，CPB期间获得性水肿与死亡率增加之间存在相关性。灌注师有可能在CPB期间优化液体平衡变化，以降低死亡率。
