Petrou A, Tzimas P, Siminelakis S
Department of Anesthesiology and Postoperative Intensive Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Hellas.
Department of Cardiothoracic Surgery, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Hellas.
Hippokratia. 2016 Jul-Sep;20(3):179-186.
Severe or massive bleeding in cardiac surgery is an uncommon but important clinical scenario. Its existing definitions are diverse. Its characteristics constantly change during an active hemorrhage and, thus is difficult to define appropriately.
In this narrative, non-systematic review, we performed a literature search to retrieve data that could contribute to answering clinical questions on the definition and grading of severe hemorrhage and massive transfusion, identifying factors that predict and affect bleeding and transfusion-related mortality and describing the risks of re-exploration and the economic impact of severe bleeding in cardiac surgery. Results: Massive perioperative bleeding is currently described by indices of its rate and extent and the magnitude of the consequent blood products transfusion. It has a significant impact on mortality, service logistics, and hospital financing. Proper and early identification of a massive bleeding is possible. Among other factors, patient's co-morbidities, bleeding severity and transfusion volume seem to predict the associated mortality. Consequent to severe bleeding, re-exploration, is also a potentially hazardous adverse event that also affects morbidity and mortality.
Severe perioperative hemorrhage in cardiac surgery carries significant morbidity and mortality. Currently, prediction and identification of massive bleeding is a feasible but incomplete clinical task despite the availability of effective treatment regimens. A still missing, compact definition of massive perioperative bleeding in cardiac surgery that incorporates all phases of treatment could augment clinical preparedness, allow for the development of accurate prediction tools and permit the application of well-validated protocols of management. Hippokratia 2016, 20(3): 179-186.
心脏手术中的严重或大量出血是一种罕见但重要的临床情况。其现有定义多种多样。在活动性出血期间其特征不断变化，因此难以恰当定义。
在本叙述性非系统综述中，我们进行了文献检索，以获取有助于回答有关严重出血和大量输血的定义及分级、识别预测和影响出血及输血相关死亡率的因素、描述再次手术探查风险以及心脏手术中严重出血的经济影响等临床问题的数据。结果：目前通过围手术期大量出血的速率、程度指标以及随之而来的血液制品输血量来描述。它对死亡率、服务后勤和医院资金有重大影响。早期准确识别大量出血是可能的。在其他因素中，患者的合并症、出血严重程度和输血量似乎可预测相关死亡率。严重出血后，再次手术探查也是一种潜在危险的不良事件，也会影响发病率和死亡率。
心脏手术中的围手术期严重出血会带来显著的发病率和死亡率。目前，尽管有有效的治疗方案，但预测和识别大量出血仍是一项可行但不完整的临床任务。一个仍缺失的、包含治疗各阶段的心脏手术围手术期大量出血的简洁定义，可能会增强临床准备，有助于开发准确的预测工具，并允许应用经过充分验证的管理方案。《希波克拉底》2016年，20(3)：179 - 186。
