Kim Eunhee, Shim Haeng Seon, Kim Won Ho, Lee Sue-Young, Park Sun-Kyung, Yang Ji-Hyuk, Jun Tae-Gook, Kim Chung Su
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Department of Anesthesiology and Pain Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
J Cardiothorac Vasc Anesth. 2016 Oct;30(5):1172-8. doi: 10.1053/j.jvca.2016.03.132. Epub 2016 Mar 16.
Laboratory hemostatic variables and parameters of rotational thromboelastometry (ROTEM) were evaluated for their ability to predict perioperative excessive blood loss (PEBL) after congenital cardiac surgery.
Retrospective and observational.
Single, large university hospital.
The study comprised 119 children younger than 10 years old undergoing congenital cardiac surgery with cardiopulmonary bypass (CPB).
Intraoperative excessive blood loss was defined as estimated blood loss≥50% of estimated blood volume (EBV). Postoperative excessive blood loss was defined as measured postoperative chest tube and Jackson-Pratt drainage≥30% of EBV over 12 hours or≥50% of EBV over 24 hours in the intensive care unit. PEBL was defined as either intraoperative or postoperative excessive blood loss. External temogram (EXTEM) and fibrinogen temogram (FIBTEM) were analyzed before and after CPB with ROTEM and laboratory hemostatic variables. Multivariate logistic regression was performed. Incidence of PEBL was 19.3% (n = 23). Independent risk factors for PEBL were CPB time>120 minutes, post-CPB FIBTEM alpha-angle, clot firmness after 10 minutes<5 mm, post-CPB EXTEM alpha-angle, clot firmness after 10 minutes<30 mm, and post-CPB EXTEM maximal lysis>20%. Laboratory hemostatic variables were not significant in multivariate analysis. The risk prediction model was developed from the results of multivariate analysis. The area under the receiver operating characteristic curve was 0.94 (95% confidence interval: 0.90-0.99).
Post-CPB ROTEM may be useful for predicting both intraoperative and postoperative excessive blood loss in congenital cardiac surgery. This study provided an accurate prediction model for PEBL and supported intraoperative transfusion guidance using post-CPB FIBTEM-A10 and EXTEM-A10.
评估实验室止血变量及旋转血栓弹力图（ROTEM）参数预测先天性心脏病手术后围手术期大量失血（PEBL）的能力。
回顾性观察研究。
大型单中心大学医院。
119例10岁以下接受体外循环（CPB）先天性心脏病手术的儿童。
术中大量失血定义为估计失血量≥估计血容量（EBV）的50%。术后大量失血定义为术后12小时胸腔闭式引流管及杰克逊-普拉特引流液量≥EBV的30%或重症监护病房24小时内≥EBV的50%。PEBL定义为术中或术后大量失血。采用ROTEM分析CPB前后的外源性凝血酶图（EXTEM）和纤维蛋白原凝血酶图（FIBTEM）以及实验室止血变量。进行多因素逻辑回归分析。PEBL发生率为19.3%（n = 23）。PEBL的独立危险因素为CPB时间>120分钟、CPB后FIBTEM的α角、10分钟后血凝块硬度<5 mm、CPB后EXTEM的α角、10分钟后血凝块硬度<30 mm以及CPB后EXTEM最大溶解率>20%。实验室止血变量在多因素分析中无显著意义。根据多因素分析结果建立风险预测模型。受试者工作特征曲线下面积为0.94（95%置信区间：0.90 - 0.99）。
CPB后的ROTEM可能有助于预测先天性心脏病手术中的术中及术后大量失血。本研究提供了一个准确的PEBL预测模型，并支持使用CPB后的FIBTEM - A10和EXTEM - A10进行术中输血指导。
