Department of Surgery, Division of Pediatric Cardiothoracic Surgery, Georgia Health Science University, Children's Medical Center, Augusta, Georgia, USA.
Ann Thorac Surg. 2013 Mar;95(3):962-7. doi: 10.1016/j.athoracsur.2012.09.029. Epub 2012 Nov 30.
Red blood cell transfusion is associated with high morbidity in pediatric patients undergoing cardiac operations. The aim of this study was to evaluate the clinical effects and outcomes of blood conservation for our pediatric patients undergoing cardiac operations.
We retrospectively analyzed a collected database of 168 pediatric patients who underwent biventricular (BV) and univentricular (UV) cardiac operations from 2006 to 2010. Patients were grouped into no blood conservation (n = 86 [BV = 74, UV = 12]) and blood conservation (n = 82 [BV = 68, UV = 14]) cohorts. There were no statistical differences in age, sex, weight, and preoperative or postoperative hemoglobin levels in the BV groups.
Even though the blood conservation group had longer cardiopulmonary bypass (CPB) (p < 0.0001) and cross-clamp times (p < 0.002) with lower hemoglobin levels (p < 0.0001), there was a decreased need for intraoperative (p < 0.0001) and postoperative blood transfusions (p < 0.018), lower inotropic scores (p < 0.0001), a decrease in ventilator days (p < 0.0009), and a shorter length of hospital stay (p < 0.0008). In the UV blood conservation group, there were no statistical differences in age, sex, weight, CPB and cross-clamp times, preoperative and postoperative hemoglobin levels, and red blood cell transfusions despite lower intraoperative hemoglobin levels (p < 0.0009) and blood transfusion (p < 0.01) requirements. There were significantly lower inotropic scores (p < 0.001) and a trend toward a shorter duration of time on the ventilator (p < 0.07) in the blood conservation group. Logistic regression analysis demonstrated a significant correlation between intraoperative blood transfusion and increased inotropic score, longer duration on the ventilator, and increased length of hospitalization.
Blood conservation in pediatric cardiac operations is associated with fewer ventilator days, lower inotropic scores, and shorter lengths of stay. These findings, in addition to attendant risks and side effects of blood transfusion and the rising cost of safer blood products, justify blood conservation in pediatric cardiac operations.
红细胞输注与儿科心脏手术患者的高发病率有关。本研究旨在评估血液保护对接受心脏手术的儿科患者的临床效果和结局。
我们回顾性分析了 2006 年至 2010 年期间接受双心室（BV）和单心室（UV）心脏手术的 168 例儿科患者的收集数据库。患者分为无血液保护（n=86[BV=74，UV=12]）和血液保护（n=82[BV=68，UV=14]）两组。BV 组在年龄、性别、体重和术前或术后血红蛋白水平方面无统计学差异。
尽管血液保护组的体外循环（CPB）（p<0.0001）和体外循环时间（p<0.002）较长，血红蛋白水平较低（p<0.0001），但术中（p<0.0001）和术后输血（p<0.018）、正性肌力药物评分（p<0.0001）、呼吸机使用天数（p<0.0009）和住院时间（p<0.0008）减少。在 UV 血液保护组中，尽管术中血红蛋白水平（p<0.0009）和输血（p<0.01）需求较低，但在年龄、性别、体重、CPB 和体外循环时间、术前和术后血红蛋白水平以及红细胞输注方面无统计学差异。血液保护组的正性肌力药物评分明显较低（p<0.001），呼吸机使用时间有缩短趋势（p<0.07）。Logistic 回归分析显示术中输血与正性肌力药物评分增加、呼吸机使用时间延长和住院时间延长显著相关。
儿科心脏手术中的血液保护与呼吸机使用天数减少、正性肌力药物评分降低和住院时间缩短有关。除了输血的风险和副作用以及更安全的血液产品的成本上升外，这些发现还证明了儿科心脏手术中的血液保护是合理的。
