Schramko A, Suojaranta-Ylinen R, Niemi T, Pesonen E, Kuitunen A, Raivio P, Salmenperä M
Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Hospital, Melahti Hospital, Helsinki, Finland
Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Hospital, Melahti Hospital, Helsinki, Finland.
Perfusion. 2015 Apr;30(3):224-32. doi: 10.1177/0267659114540022. Epub 2014 Jun 19.
Colloids and crystalloid are used during cardiac surgery for priming of the cardiopulmonary bypass (CPB) circuit. Colloids may decrease postoperative fluid balance because of their high oncotic pressure and low risk of fluid extravasation. On the other hand, colloids have been shown to impair blood coagulation.
In a prospective, randomized, double-blinded study, 50 patients scheduled for coronary artery bypass grafting or a valve procedure were planned to be randomized to receive either balanced 6% HES130/0.42 or Ringer-acetate solution for CPB priming. Randomization was stopped prematurely after 35 randomized patients (19 in the HES and 16 in the Ringer groups) because of the published report where HES130/0.42 was associated with impaired renal function. Effects on haemostasis and fluid balance were investigated.
The rotational thromboelastometry (ROTEM®) parameters and chest tube drainage on the first postoperative morning (1POM) were comparable between the groups (p>0.05). However, patients in the HES group needed more blood and blood product transfusions. The total volume administered into the CPB circuit was lower in the HES than in the Ringer (RIN) group, 2905±1049 mL versus 3973±1207 mL (p=0.011), but there was no statistically significant difference in total fluid balance on the 1POM (5086±1660 mL in the HES group versus 5850±1514 mL in the RIN group, respectively).
After complex cardiac surgery, the use of balanced 6% HES130/0.42 solution for CPB circuit priming did not impair haemostasis measured by ROTEM®, but it increased the need for transfusions. Fluid balance after CPB was less positive in the HES group, but, on the 1POM, it was comparable between the groups.
胶体液和晶体液在心脏手术中用于体外循环（CPB）回路的预充。由于胶体液具有较高的渗透压和较低的液体外渗风险，可能会减少术后液体平衡。另一方面，胶体液已被证明会损害血液凝固功能。
在一项前瞻性、随机、双盲研究中，计划将50例预定进行冠状动脉搭桥术或瓣膜手术的患者随机分为两组，分别接受平衡型6%羟乙基淀粉130/0.42（HES130/0.42）或林格氏醋酸盐溶液用于CPB预充。由于已发表的报告显示HES130/0.42与肾功能损害有关，在35例随机分组患者（HES组19例，林格氏组16例）后，随机分组提前停止。研究了对止血和液体平衡的影响。
两组术后第一个早晨（1POM）的旋转血栓弹力图（ROTEM®）参数和胸腔引流管引流量具有可比性（p>0.05）。然而，HES组患者需要更多的血液和血液制品输血。HES组输入CPB回路的总体积低于林格氏（RIN）组，分别为2905±1049 mL和3973±1207 mL（p=0.011），但1POM时的总液体平衡无统计学显著差异（HES组为5086±1660 mL，RIN组为5850±1514 mL）。
在复杂心脏手术后，使用平衡型6% HES130/0.42溶液进行CPB回路预充，通过ROTEM®测量并未损害止血功能，但增加了输血需求。CPB后HES组的液体平衡较不呈阳性，但在1POM时两组相当。
