Wang Lei, Chen Qiang, Qiu Yong Qiang, Ye Jian Xi, Du Jian Zhi, Lv Xiao Chai, Hou Yan Ting, Chen Liang Wan
Department of Cardiac Surgery, Union Hospital of Fujian Medical University, Fuzhou, Fujian Province, China.
J Cardiothorac Surg. 2020 May 27;15(1):118. doi: 10.1186/s13019-020-01151-w.
Cardiopulmonary bypass (CPB) with high-priming volume can significantly activate the inflammatory response and increse the usage of packed red blood cells (PRBCs). As risks and complications related to transfusions are increasing, many cardiac centers are focusing on reducing the priming volume of CPB. In our center, efforts have also been made to reduce the priming volume, and the effects of CPB with low-priming volume on clinical outcomes in children undergoing congenital heart disease (CHD) surgery were investigated in this study to provide referential experiences for pediatric CPB.
The clinical case data of 158 children undergoing CHD surgery with CPB were collected. The children were divided into the low-priming-volume group (group A, n = 79) and the traditional group (group B, n = 79) according to the priming volume. The amount of PRBCs transfused, the postoperative hematological test results and the clinical outcomes of the two groups were compared by the independent sample t-test or the chi-square test.
The amount of PRBCs transfused during CPB and during the whole operation were significantly lower in group A than in group B (p < 0.01), but the hemoglobin (Hb) concentration was higher in group A on the first day after surgery (p < 0.01) and before hospital discharge. However, the latter showed no statistical significant difference. The lowest postoperative platelet count was higher in group A than in group B (p < 0.05). There was no statistical difference in the postoperative inflammatory markers and the main clinical outcomes between the two groups.
The usage of PRBCs in CPB with low-priming volume decreased significantly, but the postoperative Hb concentration and platelet count could still be maintained at a high level, improving the use efficiency of PRBCs. CPB with low-priming volume did not affect the postoperative recovery of patients, so it is worthy of continuous promotion and optimization.
高预充量的体外循环（CPB）可显著激活炎症反应并增加浓缩红细胞（PRBCs）的使用量。随着输血相关风险和并发症的增加，许多心脏中心都在致力于减少CPB的预充量。在我们中心，也已努力减少预充量，本研究对低预充量CPB对先天性心脏病（CHD）手术患儿临床结局的影响进行了调查，以为小儿CPB提供参考经验。
收集158例接受CPB下CHD手术患儿的临床病例资料。根据预充量将患儿分为低预充量组（A组，n = 79）和传统组（B组，n = 79）。采用独立样本t检验或卡方检验比较两组输注PRBCs的量、术后血液学检查结果及临床结局。
A组CPB期间及整个手术过程中输注PRBCs的量显著低于B组（p < 0.01），但术后第1天及出院前A组血红蛋白（Hb）浓度较高（p < 0.01），不过后者差异无统计学意义。A组术后最低血小板计数高于B组（p < 0.05）。两组术后炎症标志物及主要临床结局无统计学差异。
低预充量CPB中PRBCs的使用量显著减少，但术后Hb浓度和血小板计数仍可维持在较高水平，提高了PRBCs的使用效率。低预充量CPB不影响患者术后恢复，因此值得持续推广和优化。
