Arıtürk Cem, Ozgen Zehra Serpil, Kilercik Meltem, Ulugöl Halim, Ökten Eyup Murat, Aksu Uğur, Karabulut Hasan, Toraman Fevzi
Department of Cardiovascular Surgery, Acibadem University, School of Medicine, Istanbul, Turkey.
Department of Anesthesiology and Reanimation, Acibadem University, School of Medicine, Istanbul, Turkey.
Heart Surg Forum. 2015 Aug 30;18(4):E154-60. doi: 10.1532/hsf.1387.
Acute kidney injury after cardiopulmonary bypass has been associated with dilutional anemia during surgery. We aimed both to explore if this relation is modulated by blood transfusion and to understand the postoperative contribution of protein oxidation.
In this randomized prospective study, after ethics committee approval and informed consent, 30 patients undergoing first-time elective coronary artery bypass grafting (CABG) with hematocrit between 21% and 25% at any time during extracorporeal circulation (ECC) were randomly and equally allocated into two groups. Group I consisted of patients who received red blood cells (RBC) during ECC, while in Group II, patients did not receive any RBCs. Besides routine hemodynamic and biochemical parameters, markers of renal injury such as neutrophil gelatinase-associated lipocalin (NGAL), creatinine clearance, and protein oxidation parameters (advanced oxidative protein products [AOPP], total thiol [T-SH]) were determined in both groups.
(1) Both cardiovascular parameters (MAP, HR) and the hospitalization period of the transfused group were not significantly different compared to the non-transfused group (P > .05); (2) While urine NGAL level (P < .05) increased and GFR (P < .01) decreased in the transfused group compared to the preoperative period, there were no significant changes in respective parameters of the non-transfused group compared to preoperative period; (3) AOPP concentrations did not change compared to postoperative periods in both groups (P > .05). However, T-SH concentration showed a transient increased at postoperative hour 6 (P < .001 vs preoperative period) but normalized at postoperative hour 24 (P > .05 versus preoperative period).
These findings suggest that a hematocrit value over 21% during ECC is safe for renal functions. RBC transfusion just to increase hematocrit may be deleterious.
体外循环后急性肾损伤与手术期间的稀释性贫血有关。我们旨在探讨这种关系是否受输血调节，并了解蛋白质氧化对术后的影响。
在这项随机前瞻性研究中，经伦理委员会批准并获得知情同意后，30例首次接受择期冠状动脉旁路移植术（CABG）的患者，在体外循环（ECC）期间任何时间血细胞比容在21%至25%之间，被随机且均等地分为两组。第一组由在ECC期间接受红细胞（RBC）的患者组成，而第二组患者未接受任何RBC。除了常规的血流动力学和生化参数外，两组均测定了肾损伤标志物，如中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、肌酐清除率和蛋白质氧化参数（晚期氧化蛋白产物[AOPP]、总巯基[T-SH]）。
（1）与未输血组相比，输血组的心血管参数（平均动脉压、心率）和住院时间均无显著差异（P＞0.05）；（2）与术前相比，输血组尿NGAL水平升高（P＜0.05），肾小球滤过率（GFR）降低（P＜0.01），而未输血组相应参数与术前相比无显著变化；（3）两组术后AOPP浓度均无变化（P＞0.05）。然而，T-SH浓度在术后6小时短暂升高（与术前相比P＜0.001），但在术后24小时恢复正常（与术前相比P＞0.05）。
这些发现表明，ECC期间血细胞比容值超过21%对肾功能是安全的。仅为提高血细胞比容而进行RBC输血可能有害。
