Bischof Dominique B, Ganter Michael T, Shore-Lesserson Linda, Hartnack Sonja, Klaghofer Richard, Graves Kirk, Genoni Michele, Hofer Christoph K
Department of Anesthesiology, Institute of Anesthesiology and Intensive Care Medicine, Triemli City Hospital, Zurich, Switzerland.
Institute of Anesthesiology and Pain Medicine, Kantonsspital Winterthur, Winterthur, Switzerland.
J Cardiothorac Vasc Anesth. 2015;29(3):715-22. doi: 10.1053/j.jvca.2015.01.015. Epub 2015 Jan 9.
The aim of the study was to determine if Sonoclot with its sensitive glass bead-activated, viscoelastic test can predict postoperative bleeding in patients undergoing cardiac surgery at predefined time points.
A prospective, observational clinical study.
A teaching hospital, single center.
Consecutive patients undergoing cardiac surgery (N = 300).
Besides routine laboratory coagulation studies and heparin management with standard (kaolin) activated clotting time, additional native blood samples were analyzed on a Sonoclot using glass bead-activated tests. Glass bead-activated clotting time, clot rate, and platelet function were recorded immediately before anesthesia induction and at the end of surgery after heparin reversal but before chest closure.
Primary outcome was postoperative blood loss (chest tube drainage at 4, 8, and 12 hours postoperatively). Secondary outcome parameters were transfusion requirements, need for surgical re-exploration, time of mechanical ventilation, length of intensive care unit and hospital stay, and hospital morbidity and mortality. Patients were categorized into "bleeders" and "nonbleeders." Patient characteristics, operations, preoperative standard laboratory parameters, and procedural times were comparable between bleeders and nonbleeders except for sex and age. Bleeders had higher rates of transfusions, surgical re-explorations, and complications. Only glass bead measurements by Sonoclot after heparin reversal before chest closure but not preoperatively were predictive for increased postoperative bleeding.
Sonoclot with its glass bead-activated tests may predict the risk for postoperative bleeding in patients undergoing cardiac surgery at the end of surgery after heparin reversal but before chest closure.
本研究旨在确定采用敏感的玻璃珠激活粘弹性检测的Sonoclot能否在预定时间点预测心脏手术患者术后出血情况。
一项前瞻性观察性临床研究。
一家教学医院，单中心。
连续接受心脏手术的患者（N = 300）。
除常规实验室凝血研究和采用标准（高岭土）激活凝血时间进行肝素管理外，还使用玻璃珠激活检测在Sonoclot上对额外的全血样本进行分析。在麻醉诱导前以及肝素逆转后但在关闭胸腔前的手术结束时，记录玻璃珠激活凝血时间、凝血速率和血小板功能。
主要结局为术后失血量（术后4、8和12小时的胸腔引流）。次要结局参数包括输血需求、再次手术探查的必要性、机械通气时间、重症监护病房住院时间和住院时间，以及医院发病率和死亡率。患者被分为“出血者”和“非出血者”。除性别和年龄外，出血者和非出血者在患者特征、手术、术前标准实验室参数和手术时间方面具有可比性。出血者的输血、再次手术探查和并发症发生率更高。仅在肝素逆转后但在关闭胸腔前而非术前通过Sonoclot进行的玻璃珠测量可预测术后出血增加。
采用玻璃珠激活检测的Sonoclot可能在肝素逆转后但在关闭胸腔前的手术结束时预测心脏手术患者术后出血风险。
