Department of Anesthesiology, German Heart Institute, Berlin, Germany.
J Thorac Cardiovasc Surg. 2013 Sep;146(3):537-42. doi: 10.1016/j.jtcvs.2012.09.101. Epub 2012 Dec 8.
Recently we suggested a comprehensive blood-sparing approach in pediatric cardiac surgery that resulted in no transfusion in 71 infants (25%), postoperative transfusion only in 68 (24%), and intraoperative transfusion in 149 (52%). We analyzed the effects of transfusion on postoperative morbidity and mortality in the same cohort of patients.
The effect of transfusion on the length of mechanical ventilation and intensive care unit stay was assessed using Kaplan-Meier curves. To assess whether transfusion independently determined the length of mechanical ventilation and length of intensive care unit stay, a multivariate model was applied. Additionally, in the subgroup of transfused infants, the effect of the applied volume of packed red blood cells was assessed.
The median length of mechanical ventilation was 11 hours (interquartile range, 9-18 hours), 33 hours (interquartile range, 18-80 hours), and 93 hours (interquartile range, 34-161 hours) in the no transfusion, postoperative transfusion only, and intraoperative transfusion groups, respectively (P < .00001). The corresponding median lengths of intensive care unit stay were 1 day (interquartile range, 1-2 days), 3.5 days (interquartile range, 2-5 days), and 8 days (interquartile range, 3-9 days; P < .00001). The multivariate hazard ratio for early extubation was 0.24 (95% confidence interval, 0.16-0.35) and 0.37 (95% confidence interval, 0.25-0.55) for the intraoperative transfusion and postoperative transfusion only groups, respectively (P < .00001). In addition, the cardiopulmonary time, body weight, need for reoperation, and hemoglobin during cardiopulmonary bypass affected the length of mechanical ventilation. Similar results were obtained for the length of intensive care unit stay. In the subgroup of transfused infants, the volume of packed red blood cells also independently affected both the length of mechanical ventilation and the length of intensive care unit stay.
The incidence and volume of blood transfusion markedly affects postoperative morbidity in pediatric cardiac surgery. These results, although obtained by retrospective analysis, might stimulate attending physicians to establish stringent blood-sparing approaches in their institutions.
最近我们提出了一种全面的儿童心脏外科学术中血液保护方法，该方法使 71 名婴儿（25%）无需输血，68 名婴儿（24%）仅在术后输血，149 名婴儿（52%）术中输血。我们分析了同一批患者的输血对术后发病率和死亡率的影响。
使用 Kaplan-Meier 曲线评估输血对机械通气时间和重症监护病房停留时间的影响。为了评估输血是否独立决定机械通气时间和重症监护病房停留时间，应用了多变量模型。此外，在输注婴儿亚组中，评估了所应用的浓缩红细胞体积的效果。
无输血、仅术后输血和术中输血组的机械通气中位时间分别为 11 小时（四分位距，9-18 小时）、33 小时（四分位距，18-80 小时）和 93 小时（四分位距，34-161 小时）（P<0.00001）。相应的重症监护病房停留时间中位数分别为 1 天（四分位距，1-2 天）、3.5 天（四分位距，2-5 天）和 8 天（四分位距，3-9 天）（P<0.00001）。术中输血和仅术后输血组的早期拔管的多变量风险比分别为 0.24（95%置信区间，0.16-0.35）和 0.37（95%置信区间，0.25-0.55）（P<0.00001）。此外，心肺转流期间的心肺时间、体重、再次手术的需要和血红蛋白也影响机械通气的时间。对于重症监护病房停留时间也得到了类似的结果。在输注婴儿亚组中，浓缩红细胞的体积也独立影响机械通气时间和重症监护病房停留时间。
输血的发生率和量明显影响小儿心脏外科学术后发病率。尽管这些结果是通过回顾性分析获得的，但可能会促使主治医生在其机构中建立严格的血液保护方法。
