Bishnoi Arvind Kumar, Garg Pankaj, Patel Kartik, Ananthanarayanan Chandrasekaran, Shah Ritesh, Solanki Atul, Pandya Himani, Patel Sanjay
Department of Cardiovascular and Thoracic Surgery UN Mehta Institute of Cardiology and Research Center and BJ Medical College, New Civil Hospital, Asarwa, India.
Department of Cardiovascular and Thoracic Surgery UN Mehta Institute of Cardiology and Research Center and BJ Medical College, New Civil Hospital, Asarwa, India.
Heart Lung Circ. 2019 May;28(5):784-791. doi: 10.1016/j.hlc.2018.03.012. Epub 2018 Mar 31.
Retrospective reviews have found the use of stored packed red blood cells (PRBCs) in priming to be associated with increased risk of postoperative complications. The purpose of study was to prospectively investigate the influence of duration of storage of PRBCs used in priming the cardiopulmonary bypass (CPB) circuit on the metabolic profile of the patients, and postoperative outcome after paediatric cardiac surgery.
Between January 2015 and December 2015, 198 consecutive children operated for cardiac surgery using CPB and received blood for priming the circuit were included. Patients were divided into two groups based on the duration of storage of the blood, newer PRBCs group who received blood stored for ≤14days and the older PRBCs group who received blood stored for >14 days.
Mean duration of blood storage used for priming in newer PRBCs blood group (n=103) was 8.4±3.7days while it was 21.9±4.5days in older PRBCs group (n=95). Metabolic parameters of the PRBCs improved to physiological limits in both the groups after initiation of CPB. Postoperative hepatic, pulmonary, haematological complications, sepsis and multi-organ failure were more in the old PRBCs group. However, the difference was not significant. Similarly, there was no significant difference in incidence of prolonged mechanical ventilation, intensive care unit stay and hospital stay and mortality between the two groups.
Metabolic parameters of the stored blood become normal after initiation of CPB irrespective of duration of storage. In paediatric patients without significant co-morbidity, undergoing cardiac surgery, transfusion of washed stored blood up to 28days in CPB priming is safe especially if lesser amount of transfusion is required.
回顾性研究发现，在预充中使用储存的浓缩红细胞（PRBCs）与术后并发症风险增加有关。本研究的目的是前瞻性调查用于体外循环（CPB）回路预充的PRBCs储存时间对患者代谢状况及小儿心脏手术后结局的影响。
纳入2015年1月至2015年12月期间连续198例行CPB心脏手术并接受血液预充回路的儿童。根据血液储存时间将患者分为两组，较新鲜PRBCs组接受储存时间≤14天的血液，较陈旧PRBCs组接受储存时间>14天的血液。
较新鲜PRBCs血型组（n = 103）用于预充的血液平均储存时间为8.4±3.7天，而较陈旧PRBCs组（n = 95）为21.9±4.5天。CPB开始后两组PRBCs的代谢参数均改善至生理极限。较陈旧PRBCs组术后肝脏、肺部、血液学并发症、败血症和多器官功能衰竭更多。然而，差异无统计学意义。同样，两组之间在机械通气时间延长、重症监护病房住院时间、住院时间和死亡率方面无显著差异。
CPB开始后，无论储存时间长短，储存血液的代谢参数均恢复正常。在无明显合并症的小儿患者行心脏手术时，CPB预充中输注储存时间长达28天的洗涤血液是安全的，尤其是在需要较少输血量的情况下。
