Servicio de Anestesiología y Cuidados Críticos, Hospital Universitario Cruces, Baracaldo, Vizcaya, España.
Servicio de Anestesiología y Cuidados Críticos, Hospital Universitario Cruces, Baracaldo, Vizcaya, España.
Rev Esp Anestesiol Reanim (Engl Ed). 2020 Jun-Jul;67(6):292-300. doi: 10.1016/j.redar.2020.01.015. Epub 2020 May 18.
Assess the reduction of packed red blood cells (PRBCs) transfusion in liver transplantation (LT) after the introduction of the thromboelastometry as intraoperative coagulation monitor.
We conducted a retrospective cohort study (n=92), randomized into two groups: groupA (control), in whom transfusion therapy was based on conventional laboratory tests (CLT), and groupB (ROTEM), whose blood transfusion was performed as protocolized algorithms, guided by thromboelastometry (ROTEM). We analyzed packed red blood cells (PRBCs) units, transfused units of fresh frozen plasma (FFP), platelets units, fibrinogen and tranexamic acid. We used the chi square test for the comparison of proportions and Student's t test to compare means when the distribution was normal. Otherwise, Mann-Whitney U test was performed.
In groupA 84.8% of patients required transfusion of PRBCs, with a median (IQR) of 4 (1.5-6), compared with 67.4% in groupB with a median (IQR) of 2 (0-4) (P<.05). We also found differences in the following variables: FFP transfusion rate was 84.8% with a median (IQR) of 5 (2-12) IU in groupA and 56.5% (median (IQR) of 1 (0-4.5) in B (P<.001) and in the fibrinogen administration, that was 6.5% in groupA and 34.8% in groupB (P<.01). Backward stepwise logistic regression model showed associations between the clamping time, the preoperative hemoglobin, the portal hypertension (PHT) and being or not in the treatment group and the need for perioperative transfusion. We didn't find significant differences in the incidence of complication during the early postoperative period between the two groups.
The introduction of thromboelastometry (ROTEM) measurements in hemostatic therapy algorithms reduces the transfusion rate of FFP and PRBCs during liver transplantation. The using of ROTEM derived thresholds leads to detecting higher requirements of fibrinogen compared to conventional laboratory tests.
评估在肝移植（LT）中引入血栓弹性描记术作为术中凝血监测后，减少输注浓缩红细胞（PRBC）的情况。
我们进行了一项回顾性队列研究（n=92），随机分为两组：A 组（对照组），其中输血治疗基于常规实验室检查（CLT）；B 组（ROTEM 组），其输血按照血栓弹性描记术（ROTEM）指导的协议化算法进行。我们分析了浓缩红细胞（PRBC）单位、新鲜冷冻血浆（FFP）单位、血小板单位、纤维蛋白原和氨甲环酸的输注情况。我们使用卡方检验比较比例，在分布正常时使用学生 t 检验比较均值。否则，使用曼-惠特尼 U 检验。
在 A 组中，84.8%的患者需要输注 PRBC，中位数（IQR）为 4（1.5-6），而 B 组中为 67.4%，中位数（IQR）为 2（0-4）（P<.05）。我们还发现以下变量存在差异：FFP 输注率在 A 组中为 84.8%，中位数（IQR）为 5（2-12）IU，在 B 组中为 56.5%（中位数（IQR）为 1（0-4.5）IU）（P<.001），纤维蛋白原给药率在 A 组中为 6.5%，在 B 组中为 34.8%（P<.01）。逐步向后逻辑回归模型显示，夹闭时间、术前血红蛋白、门静脉高压（PHT）以及是否在治疗组与围手术期输血需求之间存在关联。我们没有发现两组在术后早期并发症发生率方面存在显著差异。
在止血治疗算法中引入血栓弹性描记术（ROTEM）测量结果可降低肝移植中 FFP 和 PRBC 的输注率。与常规实验室检查相比，使用 ROTEM 衍生的阈值可检测到更高的纤维蛋白原需求。
