Oz Bilgehan Savas, Arslan Gokhan, Kaya Erkan, Gunay Celalettin, Cingoz Faruk, Arslan Mehmet
Department of Cardiovascular Surgery, Gulhane Military Academy of Medicine, Ankara, Turkey.
Cardiovasc J Afr. 2013 May;24(4):121-3, 129. doi: 10.5830/CVJA-2013-020.
The aim of this study was to determine a method to decrease the use of homologous blood during openheart surgery using a simple blood-conservation protocol. We removed autologous blood from the patient before bypass and used isovolumetric substitution. We present the results of this protocol on morbidity and mortality of surgery patients from two distinct time periods.
Patients from the two surgical phases were enrolled in this retrospective study in order to compare the outcomes using autologous or homologous blood in open-heart surgery. A total of 323 patients were included in the study. The autologous transfusion group (group 1) comprised 163 patients and the homologous transfusion group (group 2) 160 patients. In group 1, autologous bloods were prepared via a central venous catheter that was inserted into the right internal jugular vein in all patients, using the isovolumetric replacement technique. The primary outcome was postoperative In-hospital mortality and mortality at 30 days. Secondary outcomes included the length of stay in hospital and in intensive care unit (ICU), time for extubation, re-intubations, pulmonary infections, pneumothorax, pleural effusions, atrial fibrillation, other arrhythmias, renal disease, allergic reactions, mediastinitis and sternal dehiscence, need for inotropic support, and low cardiac-output syndrome (LCOS).
The mean ages of patients in groups 1 and 2 were 64.2 ± 10.3 and 61.5 ± 11.6 years, respectively. Thirty-eight of the patients in group 1 and 30 in group 2 were female. There was no in-hospital or 30-day mortality in either group. The mean extubation time, and ICU and hospital stays were significantly shorter in group 1. Furthermore, postoperative drainage amounts were less in group 1. There were significantly fewer patients with postoperative pulmonary complications, pneumonia, atrial fibrillation and renal disease. The number of patients who needed postoperative inotropic support and those with low cardiac output was also significantly less in group 1.
Autologous blood transfusion is a safe and effective method in carefully selected patients undergoing cardiac surgery. It not only prevents transfusion-related co-morbidities and complications but also enables early extubation time and shorter ICU and hospital stay. Furthermore, it reduces the cost of surgery.
本研究的目的是确定一种使用简单血液保护方案来减少心脏直视手术中同源血使用的方法。我们在体外循环前从患者体内采集自体血，并采用等容置换。我们展示了该方案在两个不同时间段对手术患者发病率和死亡率的影响结果。
为了比较心脏直视手术中使用自体血或同源血的结果，将两个手术阶段的患者纳入这项回顾性研究。共有323例患者纳入研究。自体输血组（第1组）包括163例患者，同源输血组（第2组）包括160例患者。在第1组中，所有患者均通过插入右颈内静脉的中心静脉导管，采用等容置换技术制备自体血。主要结局是术后住院死亡率和30天死亡率。次要结局包括住院时间和重症监护病房（ICU）住院时间、拔管时间、再次插管、肺部感染、气胸、胸腔积液、心房颤动、其他心律失常、肾脏疾病、过敏反应、纵隔炎和胸骨裂开、是否需要使用正性肌力药物支持以及低心排血量综合征（LCOS）。
第1组和第2组患者的平均年龄分别为64.2±10.3岁和61.5±11.6岁。第1组有38例女性患者，第2组有30例女性患者。两组均无住院期间或30天死亡率。第1组的平均拔管时间、ICU住院时间和住院时间明显更短。此外，第1组术后引流量更少。术后肺部并发症、肺炎、心房颤动和肾脏疾病的患者明显更少。第1组术后需要正性肌力药物支持的患者数量和低心排血量患者数量也明显更少。
自体输血对于精心挑选的心脏手术患者是一种安全有效的方法。它不仅能预防输血相关的合并症和并发症，还能实现早期拔管，缩短ICU住院时间和住院时间。此外，它还降低了手术成本。
