术中自体血液回收在降低初次心脏手术患者围手术期输血率方面的疗效：一项回顾性研究。
Efficacy of intraoperative cell salvage in decreasing perioperative blood transfusion rates in first-time cardiac surgery patients: a retrospective study.
作者信息
Côté Claudia L, Yip Alexandra M, MacLeod Jeffrey B, O'Reilly Bill, Murray Joshua, Ouzounian Maral, Brown Craig D, Forgie Rand, Pelletier Marc P, Hassan Ansar
机构信息
From Dalhousie Medicine, New Brunswick, Saint John, NB (Côté); Cardiovascular Research, New Brunswick Heart Center, Saint John Regional Hospital, Saint John, NB (Yip, MacLeod, Forgie, Pelletier, Hassan); Clinical Perfusion Services, Saint John Regional Hospital, Saint John, NB (O'Reilly); the Cardiovascular Data Management Centre, Hospital for Sick Children, University of Toronto, Toronto, Ont. (Murray); and the Toronto General Hospital, Toronto, Ont. (Ouzounian).
出版信息
Can J Surg. 2016 Sep;59(5):330-6. doi: 10.1503/cjs.002216.
BACKGROUND
Evidence regarding the safety and efficacy of intraoperative cell salvage (ICS) in transfusion reduction during cardiac surgery remains conflicting. We sought to evaluate the impact of routine ICS on outcomes following cardiac surgery.
METHODS
We conducted a retrospective analysis of patients who underwent nonemergent, first-time cardiac surgery 18 months before and 18 months after the implementation of routine ICS. Perioperative transfusion rates, postoperative bleeding, clinical and hematological outcomes, and overall cost were examined. We used multivariable logistic regression modelling to determine the risk-adjusted effect of ICS on likelihood of perioperative transfusion.
RESULTS
A total of 389 patients formed the final study population (186 undergoing ICS and 203 controls). Patients undergoing ICS had significantly lower perioperative transfusion rates of packed red blood cells (pRBCs; 33.9% v. 45.3% p = 0.021), coagulation products (16.7% v. 32.5% p < 0.001) and any blood product (38.2% v. 52.7%, p = 0.004). Patients receiving ICS had decreased mediastinal drainage at 12 h (mean 320 [range 230-550] mL v. mean 400 [range 260-690] mL, p = 0.011) and increased postoperative hemoglobin (mean 104.7 ± 13.2 g/L v. 95.0 ± 11.9 g/L, p < 0.001). Following adjustment for other baseline and intraoperative covariates, ICS emerged as an independent predictor of lower perioperative transfusion rates of pRBCs (odds ratio [OR] 0.52, 95% confidence interval [CI] 0.31-0.87), coagulation products (OR 0.41, 95% CI 0.24-0.71) and any blood product (OR 0.47, 95% CI 0.29-0.77). Additionally, ICS was associated with a cost benefit of $116 per patient.
CONCLUSION
Intraoperative cell salvage could represent a clinically cost-effective way of reducing transfusion rates in patients undergoing cardiac surgery. Further research on systematic ICS is required before recommending it for routine use.
背景
关于术中细胞回收（ICS）在心脏手术中减少输血方面的安全性和有效性的证据仍存在争议。我们旨在评估常规ICS对心脏手术后结局的影响。
方法
我们对在常规ICS实施前18个月和实施后18个月接受非急诊首次心脏手术的患者进行了回顾性分析。检查围手术期输血率、术后出血情况、临床和血液学结局以及总体成本。我们使用多变量逻辑回归模型来确定ICS对围手术期输血可能性的风险调整效应。
结果
共有389名患者构成最终研究人群（186名接受ICS，203名作为对照）。接受ICS的患者围手术期红细胞（pRBC）输血率显著较低（33.9%对45.3%，p = 0.021），凝血制品输血率（16.7%对32.5%，p < 0.001）以及任何血液制品输血率（38.2%对52.7%，p = 0.004）。接受ICS的患者术后12小时纵隔引流量减少（平均320[范围230 - 550]mL对平均400[范围260 - 690]mL，p = 0.011），术后血红蛋白水平升高（平均104.7±13.2g/L对95.0±11.9g/L，p < 0.001）。在对其他基线和术中协变量进行调整后，ICS成为pRBC围手术期输血率降低（优势比[OR]0.52，95%置信区间[CI]0.31 - 0.87）、凝血制品输血率降低（OR 0.41，95%CI 0.24 - 0.71）以及任何血液制品输血率降低（OR 0.47，95%CI 0.29 - 0.77）的独立预测因素。此外，ICS与每位患者116美元的成本效益相关。
结论
术中细胞回收可能是一种在心脏手术患者中降低输血率的具有临床成本效益的方法。在推荐其常规使用之前，需要对系统性ICS进行进一步研究。
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