脊柱手术期间给予平衡型6%羟乙基淀粉130/0.4后的术后失血及凝血变化：一项回顾性研究

Postoperative Blood Loss and Coagulation Changes After Balanced 6% Hydroxyethyl Starch 130/0.4 Administration During Spine Surgery: A Retrospective Study.

作者信息

Jang Myung-Soo, Han Jin-Hee, Lee SangHo, Kim Sung-Eun

机构信息

Department of Anesthesiology and Pain Medicine, Kyung Hee Medical Center.

Department of Physiology, Kyung Hee University College of Medicine, Seoul, Republic of Korea.

出版信息

Clin Spine Surg. 2019 Mar;32(2):E65-E70. doi: 10.1097/BSD.0000000000000727.

DOI:10.1097/BSD.0000000000000727

PMID:30334822

Abstract

STUDY DESIGN

Retrospective analysis.

OBJECTIVE

The objective of this study was to investigate the effects of intraoperative balanced 6% hydroxyethyl starch (HES) 130/0.4 on postoperative blood loss and the coagulation profile.

SUMMARY OF BACKGROUND DATA

The safety of colloid versus crystalloid transfusion for bleeding and coagulation during major spine surgery remains controversial and only a few studies exist. Thus, we compared the effects of balanced 6% HES 130/0.4 and crystalloid on postoperative bleeding and coagulation.

METHODS

Patients undergoing spine surgery between February 1, 2015 and February 28, 2017 were divided into 2 groups: patients receiving intraoperative balanced 6% HES 130/0.4 and patients receiving crystalloid. We compared the postoperative bleeding volume with changes in the coagulation profile and length of hospital stay between these 2 groups. Propensity score (PS)-matching and multivariate stepwise linear regression were performed.

RESULTS

A total of 169 patients who met the inclusion criteria were analyzed. The quantity of total colloid per patient was 10-15 mL/kg. A significant difference was observed in the total intraoperative transfused crystalloid volume between the 2 groups (colloid group, 1.394.6±1.414.0 mL; crystalloid group, 2.027.3±1.114.1 mL; P<0.001). Postoperative blood loss and coagulation profile changes were not significantly different in the 60 PS-matched paired patients. Furthermore, no differences in either postoperative transfusion requirement or length of hospital stay were observed between the groups. Multivariate stepwise linear regression revealed that operation time (β=0.549; P<0.001) and intraoperative transfusion of packed red blood cells (β=0.466; P=0.003) or fresh frozen plasma (β=-0.263; P=0.041) were independently associated with postoperative blood loss. However, intraoperative colloid administration was not a predictive factor.

CONCLUSIONS

Intraoperative infusion of balanced 6% HES 130/0.4 in patients undergoing spine surgery presented clinically insignificant changes in postoperative blood loss and coagulation compared to crystalloid.

LEVEL OF EVIDENCE

Level III.

摘要

研究设计

回顾性分析。

目的

本研究旨在探讨术中输注平衡型6%羟乙基淀粉（HES）130/0.4对术后失血量及凝血指标的影响。

背景资料总结

在脊柱大手术中，胶体液与晶体液输注对于出血和凝血的安全性仍存在争议，相关研究较少。因此，我们比较了平衡型6% HES 130/0.4与晶体液对术后出血和凝血的影响。

方法

将2015年2月1日至2017年2月28日期间接受脊柱手术的患者分为两组：术中接受平衡型6% HES 130/0.4的患者和接受晶体液的患者。我们比较了两组患者的术后失血量、凝血指标变化及住院时间。进行了倾向评分（PS）匹配和多因素逐步线性回归分析。

结果

共分析了169例符合纳入标准的患者。每位患者的胶体液总量为10 - 15 mL/kg。两组患者术中输注的晶体液总量存在显著差异（胶体液组，1.394.6±1.414.0 mL；晶体液组，2.027.3±1.114.1 mL；P<0.001）。在60对PS匹配的患者中，术后失血量和凝血指标变化无显著差异。此外，两组患者术后输血需求和住院时间均无差异。多因素逐步线性回归显示，手术时间（β=0.549；P<0.001）、术中输注浓缩红细胞（β=0.466；P=0.003）或新鲜冰冻血浆（β=-0.263；P=0.041）与术后失血量独立相关。然而，术中输注胶体液并非预测因素。