Stein Louis H, Rubinfeld Gregory, Balsam Leora B, Ursomanno Patricia, DeAnda Abe
Division of Cardiothoracic Surgery, SUNY Downstate Medical Center, Brooklyn, New York, USA.
Department of Cardiothoracic Surgery, NYU Langone Medical Center, New York, New York, USA.
Aorta (Stamford). 2017 Aug 1;5(4):106-116. doi: 10.12945/j.aorta.2017.16.049. eCollection 2017 Aug.
We determined the impact of intraoperative hypothermia on postoperative bleeding after thoracic aortic surgery.
We retrospectively analyzed 98 consecutive patients who underwent aortic surgery with deep hypothermic circulatory arrest between 2010 and 2014. We evaluated lowest temperature, absolute decrease in temperature, and rewarming rate. Univariate and multivariate regression were used to determine relationships between temperature, clinical characteristics, and measures of postoperative bleeding.
The mean age of patients was 60.5 ± 15.1 years, with 64.3% male and 60% Caucasian. The lowest temperatures recorded were 13.5 ± 4.6°C at the bypass circuit. Change in hematocrit was associated with ethnicity, preoperative hematocrit, and rewarming rate. Chest tube output was associated with body mass index, preoperative platelet count, prior cardiac surgery, cardiopulmonary bypass (CPB) duration, intraoperative blood product transfusion, lowest surface temperature, and change in surface temperature. Postoperative packed red blood cell transfusion was associated with ejection fraction, chronic obstructive pulmonary disease (COPD), platelet count, partial thromboplastin time, CPB duration, and lowest blood temperature. Fresh frozen plasma transfusion correlated with COPD, CPB duration, and final blood temperature. Platelet transfusion correlated with body mass index and preoperative platelet count. Unplanned reoperation for bleeding was associated with final temperature and change in temperature.
We found no consistent associations between intraoperative temperature and indicators of bleeding. Intraoperative cooling strategies should be based on optimal end-organ protection rather than fear of postoperative bleeding; rewarming strategies may ameliorate the risk of coagulopathy.
我们确定了术中低温对胸主动脉手术后出血的影响。
我们回顾性分析了2010年至2014年间连续98例行深低温停循环主动脉手术的患者。我们评估了最低体温、体温绝对下降值和复温速率。采用单因素和多因素回归分析来确定体温、临床特征与术后出血指标之间的关系。
患者的平均年龄为60.5±15.1岁，男性占64.3%，白种人占60%。体外循环回路记录的最低体温为13.5±4.6°C。血细胞比容的变化与种族、术前血细胞比容和复温速率有关。胸管引流量与体重指数、术前血小板计数、既往心脏手术、体外循环（CPB）时间、术中血液制品输注、最低体表温度和体表温度变化有关。术后浓缩红细胞输注与射血分数、慢性阻塞性肺疾病（COPD）、血小板计数、部分凝血活酶时间、CPB时间和最低血温有关。新鲜冰冻血浆输注与COPD、CPB时间和最终血温有关。血小板输注与体重指数和术前血小板计数有关。因出血进行的非计划再次手术与最终体温和体温变化有关。
我们发现术中体温与出血指标之间没有一致的关联。术中降温策略应基于最佳的终末器官保护，而非担心术后出血；复温策略可能会降低凝血功能障碍的风险。
