Ranucci Marco, Baryshnikova Ekaterina, Ciotti Erika, Ranucci Matteo, Silvetti Simona
Department of Cardiothoracic and Vascular Anesthesia and Intensive Care Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
Department of Cardiothoracic and Vascular Anesthesia and Intensive Care Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
J Cardiothorac Vasc Anesth. 2017 Oct;31(5):1588-1594. doi: 10.1053/j.jvca.2017.04.014. Epub 2017 Apr 13.
Hemodilution has been associated with both hypocoagulability and hypercoagulability in studies based on thromboelastography (TEG). Severe hemodilution during cardiopulmonary bypass (CPB) is a risk factor for morbidity in cardiac surgery. This study investigated the effects of different degrees of hemodilution with CPB on post-CPB TEG parameters and coagulation-related outcomes.
Retrospective cohort study.
University research hospital.
The study comprised 793 cardiac surgery patients.
None.
The patient population was divided into low (LH), moderate (MH), and severe (SH) hemodilution groups based on the hemodilution degree on CPB. Differences in TEG parameters and coagulation-related outcomes were assessed. Patients with SH experienced significantly (p = 0.019) prolonged clotting times (median r-time 6.1 min, interquartile range 5.1-7.4 min) with respect to patients with MH (median r-time 5.8 min, interquartile range 4.8-7 min) and LH (median r-time 5.9 min, interquartile range 4.8-7.2 min). Clot firmness was significantly (p = 0.001) lower in patients with SH (median maximum amplitude 63 mm, interquartile range 57-68 mm) compared with patients with MH (median maximum amplitude 65 mm, interquartile range 61-71 mm) and LH (median maximum amplitude 67 mm, interquartile range 62-74 mm). Patients with SH had higher chest drain blood loss and required more fresh frozen plasma and platelet concentrate transfusions than did patients with MH or LH. Postoperative thromboembolic complications were significantly (p = 0.006) more common in patients with SH (2.6%) than in patients with MH (0%) or LH (0.4%).
SH on CPB is associated with hypocoagulation, bleeding, and thrombosis-associated worse outcomes.
在基于血栓弹力图（TEG）的研究中，血液稀释与低凝性和高凝性均有关联。体外循环（CPB）期间的严重血液稀释是心脏手术发病的一个危险因素。本研究调查了CPB不同程度的血液稀释对CPB后TEG参数及凝血相关结局的影响。
回顾性队列研究。
大学研究医院。
该研究纳入了793例心脏手术患者。
无。
根据CPB时的血液稀释程度，将患者人群分为轻度（LH）、中度（MH）和重度（SH）血液稀释组。评估TEG参数及凝血相关结局的差异。与MH组（r时间中位数5.8分钟，四分位间距4.8 - 7分钟）和LH组（r时间中位数5.9分钟，四分位间距4.8 - 7.2分钟）相比，SH组患者的凝血时间显著延长（p = 0.019）（r时间中位数6.1分钟，四分位间距5.1 - 7.4分钟）。与MH组（最大振幅中位数65毫米，四分位间距61 - 71毫米）和LH组（最大振幅中位数67毫米，四分位间距62 - 74毫米）相比，SH组患者的血凝块强度显著降低（p = 0.001）（最大振幅中位数63毫米，四分位间距57 - 68毫米）。SH组患者的胸腔引流量失血更多，比MH组或LH组患者需要更多的新鲜冰冻血浆和血小板浓缩液输注。SH组患者术后血栓栓塞并发症的发生率（2.6%）显著高于MH组（0%）或LH组（0.4%）（p = 0.006）。
CPB期间的重度血液稀释与低凝、出血以及血栓形成相关的更差结局有关。
