Ghavidel Alireza Alizadeh, Toutounchi Zia, Shahandashti Farshad Jalili, Mirmesdagh Yalda
Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
Asian Cardiovasc Thorac Ann. 2015 Jun;23(5):525-9. doi: 10.1177/0218492314566330. Epub 2015 Jan 12.
Reexploration and its associated complications significantly affect hospital mortality and morbidity. Therefore, to prevent postoperative bleeding and its related complications, using an appropriate modality is essential during cardiac surgery.
Four hundred patients (296 males and 104 females, mean age 60.8 ± 9 years) scheduled for first-time coronary artery bypass graft surgery were prospectively enrolled. Blood samples were obtained for ROTEM testing before surgery and 30 min after heparin reversal. The patients were divided into 2 groups: group 1 was patients with no abnormal postoperative bleeding and group 2 was patients who required reexploration for abnormal postoperative bleeding. Group 2 patients were divided into 2 subgroups: 2a was patients with surgical bleeding and group 2b was patients with nonsurgical bleeding. Variables were compared between groups.
Among the 400 patients, 42 were reexplored. Hospital stay was significantly longer and hospital deaths more frequent in group 2 patients (p < 0.001 and p = 0.010, respectively). Ten (2.8%) patients had abnormal preoperative results of ROTEM in group 1 compared to 14 (33.3%) in group 2 (p < 0.001). After surgery, the number of patients with abnormal ROTEM results was significantly different between the 2 groups: 6 (1.7%) in group 1 vs. 14 (33.3%) in group 2 (p < 0.001). Four (12.5%) patients in group 2a had abnormal preoperative ROTEM results compared to 10 (100%) in group 2a (p < 0.001).
Measuring coagulation factors by ROTEM both before surgery and after heparin reversal can identify patients at increased risk of postoperative bleeding.
再次手术探查及其相关并发症会显著影响医院死亡率和发病率。因此，为预防术后出血及其相关并发症，在心脏手术期间采用适当的方式至关重要。
前瞻性纳入400例计划首次行冠状动脉旁路移植术的患者（296例男性和104例女性，平均年龄60.8±9岁）。在手术前和肝素逆转后30分钟采集血样进行旋转血栓弹力图（ROTEM）检测。患者分为两组：第1组为术后无异常出血的患者，第2组为因术后异常出血需要再次手术探查的患者。第2组患者再分为两个亚组：2a组为手术出血患者，2b组为非手术出血患者。对组间变量进行比较。
400例患者中，42例接受了再次手术探查。第2组患者的住院时间明显更长，医院死亡更频繁（分别为p<0.001和p=0.010）。第1组中有10例（2.8%）患者术前ROTEM结果异常，而第2组中有14例（33.3%）（p<0.001）。手术后，两组间ROTEM结果异常的患者数量有显著差异：第1组为6例（1.7%），第2组为14例（33.3%）（p<0.001）。2a组中有4例（12.5%）患者术前ROTEM结果异常，而2b组中有10例（100%）（p<0.001）。
在手术前和肝素逆转后通过ROTEM测量凝血因子可以识别术后出血风险增加的患者。
