Department of Anesthesiology, Tokyo Women's Medical University Medical Center East.
Circ J. 2018 Feb 23;82(3):677-683. doi: 10.1253/circj.CJ-17-0712. Epub 2017 Dec 13.
Coagulopathy after cardiopulmonary bypass (CPB) is caused by multiple factors, including reduced coagulation factors and a low platelet count.Methods and Results:In this study, we undertook a post hoc analysis to identify factors associated with increased postoperative blood loss in 97 patients undergoing cardiac surgery with CPB, with fresh frozen plasma administered according to a ROTEM-guided algorithm. We identified 24 patients for the top quartile of postoperative blood loss, >528 mL and defined as having excessive blood loss. Using Spearman's rank correlation test and multivariable linear regression, we reanalyzed the participants' demographic, surgical and anesthetic variables, laboratory test results, blood loss, and transfusion data. Univariate analysis indicated that patients who experienced higher postoperative blood loss received a significantly higher heparin dose, had a higher requirement for fresh frozen plasma transfusion during surgery, and had a significantly lower hematocrit and platelet count at the end of surgery compared with patients without excessive blood loss. Multivariate analysis showed that platelet count at the end of surgery (odds ratio 0.780, 95% confidence interval 0.629-0.967; P=0.024) was an independent factor for excessive blood loss.
Low platelet count at the end of surgery was associated with excessive postoperative bleeding during cardiac surgery with CPB.
体外循环（CPB）后发生的凝血功能障碍是由多种因素引起的，包括凝血因子减少和血小板计数降低。
在这项研究中，我们进行了一项事后分析，以确定 97 例行 CPB 心脏手术患者术后出血量增加的相关因素，这些患者根据 ROTEM 指导的算法输注新鲜冰冻血浆。我们确定了 24 名患者的术后出血量处于前四分之一，即>528ml，定义为出血过多。使用 Spearman 等级相关检验和多变量线性回归，我们重新分析了参与者的人口统计学、手术和麻醉变量、实验室检查结果、出血量和输血数据。单因素分析表明，与没有出血过多的患者相比，出血量较高的患者术后肝素剂量明显更高，术中需要输注新鲜冰冻血浆的需求更高，且术终时的血细胞比容和血小板计数明显更低。多变量分析显示，术终血小板计数（比值比 0.780，95%置信区间 0.629-0.967；P=0.024）是术后出血过多的独立因素。
CPB 心脏手术后术终血小板计数低与术后出血过多有关。
