Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA.
Department of Surgery, Division of Cardiothoracic Surgery, Oregon Health & Science University, Portland, OR, USA.
Acta Anaesthesiol Scand. 2018 Jul;62(6):756-764. doi: 10.1111/aas.13095. Epub 2018 Mar 4.
Acute normovolemic hemodilution (ANH) is considered safe and effective in decreasing perioperative transfusion in paediatric populations undergoing high blood-loss surgeries. We determined the association between ANH and the intraoperative use of allogeneic blood products in paediatric cardiac surgery patients.
This is a single-centre retrospective cohort study including paediatric patients between 0 and 36 months of age undergoing surgical repair or palliation of their cardiac defect with the use of cardiopulmonary bypass between November 2013 and November 2014. Our primary endpoint was the volume per kilogram of body weight of any blood product administered. Secondary endpoints were postoperative bleeding, coagulation profile, creatinine, vasoactive support, duration of mechanical ventilation, and hospital stay.
In all, 50 patients met eligibility criteria and were included. Of those, seven were exposed to ANH and while 43 patients were treated according to usual care. Baseline characteristics were similar in both groups. After adjustment for baseline characteristics including age, American Society of Anaesthesiologists (ASA) classification, and Risk Adjusted Congenital Heart Surgery score, ANH was associated with reduced administration of allogenic blood products, with the mean difference between groups of 57.5 ml/kg (95% CI: 34.8, 80.2). The ANH group had lower blood losses at 6 and 24 h postoperatively. There were no differences in the duration of ICU or hospital stay.
We found a reduction in the administration of blood products and lower postoperative blood losses associated with the use of ANH in paediatric cardiac surgery patients. The data suggest that ANH might be beneficial in reducing perioperative morbidity in this patient population.
急性等容血液稀释（ANH）被认为在减少儿童接受高失血手术时的围手术期输血方面是安全且有效的。我们确定了 ANH 与儿科心脏手术患者术中异体血液制品使用之间的关联。
这是一项单中心回顾性队列研究，纳入了 2013 年 11 月至 2014 年 11 月期间因心脏缺陷接受心肺旁路手术修复或姑息治疗的 0 至 36 个月龄儿童患者。我们的主要终点是每公斤体重给予的任何血液制品的体积。次要终点是术后出血、凝血谱、肌酐、血管活性支持、机械通气时间和住院时间。
共有 50 名患者符合入选标准并被纳入研究。其中 7 名患者接受了 ANH，而 43 名患者则按照常规护理进行治疗。两组患者的基线特征相似。在调整了年龄、美国麻醉医师协会（ASA）分级和风险调整先天性心脏病手术评分等基线特征后，ANH 与异体血液制品的使用减少相关，组间差异的平均值为 57.5ml/kg（95%CI：34.8，80.2）。ANH 组术后 6 小时和 24 小时的出血量较低。两组 ICU 或住院时间无差异。
我们发现，在儿科心脏手术患者中，使用 ANH 可减少血液制品的使用和降低术后出血量。数据表明，ANH 可能有益于减少该患者人群的围手术期发病率。
