[体外循环心脏手术围手术期纤维蛋白原浓度]
[Perioperative fibrinogen concentrations in cardiac surgery with cardiopulmonary bypass].
作者信息
Uji Makiko, Terada Yuki, Noguchi Teruo, Nishida Takaya, Hasuwa Kyoko, Shinohara Kozue, Kumano Hotaka, Ishimura Naoko, Nishiwada Makoto
机构信息
Department of Anesthesia, Tenri Hospital, Tenri 632-8552.
出版信息
Masui. 2012 Aug;61(8):814-9.
BACKGROUND
Patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) need many blood products due to deficiency of coagulation factors. Blood transfusion therapy in patients with excessive bleeding after CPB is generally empiric. We checked and studied the fibrinogen concentration and transfusion, as well as bleeding amount in the perioperative period.
METHODS
The study was approved by our institutional ethics committee. Thirty patients were studied. Blood samples were obtained at the induction of anesthesia (before CPB), at the end of CPB, at the end of operation, and on the next morning, or before the patient was given fresh frozen plasma in the intensive care unit.
RESULTS
For all cases, fibrinogen concentration and platelet concentration were lowest at the end of CPB. Fibrinogen concentration rose up to before CPB level on the next morning. The group in which fibrinogen concentration was less than 150 mg x dl(-1) at the end of CPB consumed more blood products than the group with fibrinogen concentration of over 150 mg x dl(-1).
CONCLUSIONS
Blood transfusion therapy based on fibrinogen concentration is needed to maintain adequacy of the perioperative blood transfusion and blood conservation in cardiac surgery.
背景
接受体外循环（CPB）心脏手术的患者因凝血因子缺乏需要多种血液制品。CPB后出血过多患者的输血治疗通常是经验性的。我们检查并研究了围手术期纤维蛋白原浓度、输血情况以及出血量。
方法
本研究经机构伦理委员会批准。对30例患者进行了研究。在麻醉诱导时（CPB前）、CPB结束时、手术结束时以及次日早晨，或在重症监护病房患者接受新鲜冰冻血浆之前采集血样。
结果
所有病例中，CPB结束时纤维蛋白原浓度和血小板浓度最低。次日早晨纤维蛋白原浓度升至CPB前水平。CPB结束时纤维蛋白原浓度低于150mg·dl⁻¹的组比纤维蛋白原浓度高于150mg·dl⁻¹的组消耗更多血液制品。
结论
需要基于纤维蛋白原浓度的输血治疗来维持心脏手术围手术期输血的充足性和血液保护。
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