Yaffee David W, DeAnda Abe, Ngai Jennie Y, Ursomanno Patricia A, Rabinovich Annette E, Ward Alison F, Galloway Aubrey C, Grossi Eugene A
Departments of Cardiothoracic Surgery.
Anesthesiology, NYU Langone Medical Center, New York, NY.
J Cardiothorac Vasc Anesth. 2015;29(3):703-9. doi: 10.1053/j.jvca.2014.10.022. Epub 2015 Apr 4.
The present study aimed to evaluate the effect of blood conservation strategies on patient outcomes after aortic surgery.
Retrospective cohort analysis of prospective data.
University hospital.
Patients undergoing thoracic aortic surgery.
One hundred thirty-two consecutive high-risk patients (mean EuroSCORE 10.4%) underwent thoracic aortic aneurysm or dissection repair from January 2010 to September 2011. A blood conservation strategy (BCS) focused on limitation of hemodilution and tolerance of perioperative anemia was used in 57 patients (43.2%); the remaining 75 (56.8%) patients were managed by traditional methods. Mortality, major complications, and red blood cell transfusion requirements were assessed. Independent risk factors for clinical outcomes were determined by multivariate analyses.
Hospital mortality was 9.8% (13 of 132). Lower preoperative hemoglobin was an independent predictor of mortality (p<0.01, odds ratio [OR] 1.7). Major complications were associated with perioperative transfusion: 0% complication rate in patients receiving<2 units of packed red blood cells versus 32.3% (20 of 62) in patients receiving ≥2 units. The blood conservation strategy had no significant impact on mortality (p = 0.4) or major complications (p = 0.9) despite the blood conservation patients having a higher incidence of aortic dissection and urgent/emergent procedures and lower preoperative and discharge hemoglobin. In patients with aortic aneurysms, BCS patients received 1.5 fewer units of red blood cells (58% reduction) than non-BCS patients (p = 0.01). Independent risk factors for transfusion were lower preoperative hemoglobin (p<0.01, OR 1.5) and lack of BCS (p = 0.02, OR 3.6).
Clinical practice guidelines for blood conservation should be considered for high-risk complex aortic surgery patients.
本研究旨在评估血液保护策略对主动脉手术后患者预后的影响。
对前瞻性数据进行回顾性队列分析。
大学医院。
接受胸主动脉手术的患者。
2010年1月至2011年9月期间，132例连续的高危患者（平均欧洲心脏手术风险评估系统[EuroSCORE]为10.4%）接受了胸主动脉瘤或夹层修复手术。57例患者（43.2%）采用了以限制血液稀释和耐受围手术期贫血为重点的血液保护策略（BCS）；其余75例（56.8%）患者采用传统方法治疗。评估死亡率、主要并发症和红细胞输注需求。通过多变量分析确定临床结局的独立危险因素。
医院死亡率为9.8%（132例中的13例）。术前血红蛋白水平较低是死亡率的独立预测因素（p<0.01，比值比[OR]为1.7）。主要并发症与围手术期输血有关：接受<2单位浓缩红细胞的患者并发症发生率为0%，而接受≥2单位的患者并发症发生率为32.3%（62例中的20例）。尽管采用血液保护策略的患者主动脉夹层和急诊/紧急手术的发生率较高，术前和出院时血红蛋白水平较低，但血液保护策略对死亡率（p = 0.4）或主要并发症（p = 0.9）没有显著影响。在主动脉瘤患者中，采用BCS的患者比未采用BCS的患者少接受1.5单位红细胞（减少58%）（p = 0.01）。输血的独立危险因素是术前血红蛋白水平较低（p<0.01，OR为1.5）和未采用BCS（p = 0.02，OR为3.6）。
对于高危复杂主动脉手术患者，应考虑制定血液保护的临床实践指南。
