Department of Cardiothoracic Surgery, Sahlgrenska University Hospital , Gothenburg , Sweden.
Scand Cardiovasc J. 2013 Dec;47(6):368-76. doi: 10.3109/14017431.2013.838640. Epub 2013 Sep 16.
Cardiotomy suction blood in volumes corresponding to 10-20% of the systemic blood volume is retransfused during cardiopulmonary bypass. We hypothesized that retransfusion of unwashed cardiotomy suction blood influences coagulation and platelet function.
Systemic blood samples collected during cardiopulmonary bypass were supplemented ex vivo with autologous wound blood (5, 10 and 20%, respectively). Clot formation and platelet function were assessed with thromboelastometry and platelet aggregometry. In an in vivo pilot study 30 patients were randomized into a retransfusion and a no-retransfusion group. Clot formation, platelet aggregability and thrombin generation capacity were compared between the groups.
Cardiotomy suction blood had markedly impaired clot stability and reduced levels of fibrinogen and platelets compared with systemic blood. Ex vivo addition of 10% and 20% suction blood to systemic blood impaired platelet aggregability and clot stability. Retransfusion of small amounts of wound blood in vivo (mean volume 280 ml, corresponding to 5% of the blood volume) did not significantly influence haemostasis.
The ex vivo results suggest that addition of unwashed cardiotomy suction blood in clinically relevant volumes impairs systemic haemostasis. Retransfusion of smaller volumes in vivo has no or limited impact. Avoiding retransfusion of larger amounts of unwashed cardiotomy suction may improve postoperative haemostasis.
体外循环期间，将相当于全身血容量 10-20%的心血吸引血回输。我们假设未清洗的心血吸引血回输会影响凝血和血小板功能。
体外循环期间收集的全身血液样本分别用自体伤口血（分别为 5%、10%和 20%）进行体外补充。使用血栓弹性描记术和血小板聚集仪评估血栓形成和血小板功能。在一项体内初步研究中，将 30 例患者随机分为回输组和不回输组。比较两组之间的血栓形成、血小板聚集性和凝血酶生成能力。
与全身血液相比，心血吸引血的血栓稳定性明显降低，纤维蛋白原和血小板水平降低。将 10%和 20%的吸引血体外加入全身血液会损害血小板聚集性和血栓稳定性。体内少量回输伤口血（平均体积 280ml，相当于血容量的 5%）不会显著影响止血。
体外结果表明，加入临床相关量的未清洗心血吸引血会损害全身止血功能。体内回输较小体积的血液没有或影响有限。避免回输大量未清洗的心血吸引可能会改善术后止血。
