From the Departments of Anaesthesiology, Intensive Care Medicine and Pain Therapy.
Thoracic and Cardiovascular Surgery, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt/Main, Germany.
Anesth Analg. 2020 May;130(5):1389-1395. doi: 10.1213/ANE.0000000000004693.
Cardiothoracic surgery is associated with major blood loss and allogeneic transfusion of red blood cell concentrates. To minimize allogeneic red blood cell (RBC) transfusion, intraoperative cell salvage has been effectively used for years. The objective of this study was to evaluate the impact of cell salvage on blood coagulation factors.
We enrolled 30 patients scheduled for cardiac surgery in a prospective single-center observational cohort study at an academic hospital. Blood samples from the cell salvage system were obtained from both the reservoir and the processed red blood cell concentrate. Coagulation factors, fibrinogen, antithrombin and von Willebrand activity, and antigen were assessed before and after cell salvage. Statistical analysis was performed using Wilcoxon matched-pairs signed rank test.
Our results revealed a significant decrease of fibrinogen (P < .001), coagulation factors II (P = .004), factors VII, X, and XIII (P < .001), and all other measured coagulation factor concentrations/activities in the processed red blood cell concentrate, when compared to the concentrations/activities of the reservoir.
The results of the present study revealed a significant reduction of coagulation factor concentrations/activities by the washing process. Therefore, physicians need to consider adequate management of coagulation in patients with major blood loss and the need of large volumes of RBC transfusion.
心胸外科手术会导致大量失血和异体输红细胞浓缩物。为了尽量减少异体红细胞（RBC）输血，术中回收式血液采集已被有效应用多年。本研究旨在评估血液回收对凝血因子的影响。
我们在一家学术医院进行了一项前瞻性单中心观察性队列研究，共纳入 30 名计划接受心脏手术的患者。从储血器和处理后的红细胞浓缩物中采集血液回收系统的血样。在血液回收前后评估凝血因子、纤维蛋白原、抗凝血酶和血管性血友病因子活性及抗原。采用 Wilcoxon 配对符号秩检验进行统计学分析。
我们的结果显示，与储血器相比，处理后的红细胞浓缩物中的纤维蛋白原（P <.001）、凝血因子 II（P =.004）、因子 VII、X 和 XIII（P <.001）以及所有其他测量的凝血因子浓度/活性显著降低。
本研究结果表明，洗涤过程会显著降低凝血因子的浓度/活性。因此，对于大量失血和需要大量输红细胞的患者，医生需要考虑对凝血进行充分管理。
