Pieri M, Nardelli P, De Luca M, Landoni G, Frassoni S, Melissano G, Zangrillo A, Chiesa R, Monaco F
Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
Eur J Vasc Endovasc Surg. 2017 Mar;53(3):347-353. doi: 10.1016/j.ejvs.2016.12.016. Epub 2017 Jan 6.
Thoraco-abdominal aortic aneurysm (TAAA) repair is a complex procedure performed in patients at high cardiovascular risk. High volume intra-operative bleeding is often recorded, and the amount of intra-operative blood product transfusion is associated with relevant morbidity and mortality. The aim of the study was to identify pre-operative predictors of intra-operative large volume blood transfusions (LVBT) to stratify patients pre-operatively.
This was a retrospective analysis of prospectively collected data of all patients who underwent open TAAA surgery at San Raffaele Scientific Institute from January 2009 to December 2015. Intra-operative red blood cell (RBC) transfusions were administered to maintain a hematocrit of at least 30%. A LVBT was defined as a transfusion of at least four RBC units, corresponding to 1000 mL.
The study population included 428 patients: 260 (61%) received fewer than 4 RBC units, and 168 (39%) were transfused with at least 4 RBC units. In patients who underwent LVBT, higher mortality was observed after surgery (p=.003), longer intensive care unit admission (p=.004), and longer mechanical ventilation compared with less transfused patients (p=.0002). The patients who received fewer units were administered a higher dose of heparin during the surgical operation compared with patients of the LVBT group: 3400±1100 vs. 2900±1300 IU (international units) (p=.0004). Pre-operative chronic renal failure (OR 1.8), the pre-operative haemoglobin value (OR 0.8), and the need for urgent or emergent surgery (OR 3.15) were independent predictors of LVBT on multivariate analysis.
The identification of patients at risk of intra-operative LVBT during TAAA surgery is critical as these patients experience a worse outcome. Nevertheless, only few independent predictors are available for clinical practice.
胸腹主动脉瘤（TAAA）修复术是一项针对心血管风险较高患者实施的复杂手术。术中经常出现大量出血情况，术中血液制品的输注量与相关的发病率和死亡率相关。本研究的目的是确定术中大量输血（LVBT）的术前预测指标，以便在术前对患者进行分层。
这是一项对2009年1月至2015年12月在圣拉斐尔科学研究所接受开放性TAAA手术的所有患者的前瞻性收集数据进行的回顾性分析。术中输注红细胞（RBC）以维持血细胞比容至少为30%。LVBT定义为至少输注4个RBC单位，相当于1000毫升。
研究人群包括428例患者：260例（61%）输注少于4个RBC单位，168例（39%）输注至少4个RBC单位。与输注较少的患者相比，接受LVBT的患者术后死亡率更高（p = 0.003），重症监护病房住院时间更长（p = 0.004），机械通气时间更长（p = 0.0002）。与LVBT组患者相比，输注单位较少的患者在手术过程中接受的肝素剂量更高：3400±1100 vs. 2900±1300国际单位（IU）（p = 0.0004）。多因素分析显示，术前慢性肾功能衰竭（OR 1.8）、术前血红蛋白值（OR 0.8）以及急诊或紧急手术需求（OR 3.15）是LVBT的独立预测指标。
识别TAAA手术中存在术中LVBT风险的患者至关重要，因为这些患者的预后较差。然而，临床实践中可用的独立预测指标很少。
