Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA.
Department of Anesthesiology, Yale University, New Haven, CT, USA.
World J Pediatr Congenit Heart Surg. 2020 Jul;11(4):452-458. doi: 10.1177/2150135120923627.
Due to the substantial improvement in survival among pediatric patients undergoing congenital heart surgery, reducing early and long-term morbidity is becoming the major focus of care. Blood transfusion is associated with worse postoperative outcomes after cardiac surgery. Acute normovolemic hemodilution (ANH) is a blood conservation strategy that aims to reduce allogenic blood transfusion during cardiac surgery. However, there are scant data regarding its efficacy for pediatric cardiac surgery patients.
We designed a single-center, controlled, randomized, pilot trial in patients between 6 and 36 months old undergoing pediatric heart surgery. Patients were equally assigned to undergo ANH prior to initiation of cardiopulmonary bypass or to be managed per usual care. The primary end point was the amount of blood product transfused perioperatively. Secondary end points were markers of morbidity: postoperative bleeding, hematocrit, inotropic agents use, intensive care unit, and hospital stay. The analysis was by intention-to-treat. Estimates of differences between groups are presented with 95% CIs.
Twelve pediatric heart surgery patients were randomized to each group, ANH and usual care. Baseline characteristics were similar between groups. Acute normovolemic hemodilution implementation did not result in a reduction in the administration of blood product transfused (difference between ANH and usual care among patients transfused = -1.4 mL [-29.4 to 26.6], = .92). Secondary end points were not different between groups.
In this small trial of pediatric cardiac surgery patients, ANH as a strategy to reduce blood component therapy was safe; however, the study failed to show a reduction in perioperative transfusion or other postoperative outcomes.
由于接受先天性心脏手术的儿科患者的生存率有了实质性提高，减少早期和长期发病率已成为关注的主要焦点。输血与心脏手术后的术后结果较差有关。急性等容血液稀释（ANH）是一种血液保存策略，旨在减少心脏手术期间的异体输血。然而，关于其对儿科心脏手术患者的疗效的数据很少。
我们在 6 至 36 个月大的接受小儿心脏手术的患者中设计了一项单中心、对照、随机、试验性试验。患者被平均分配为在体外循环开始前进行 ANH 或接受常规护理。主要终点是围手术期输血的量。次要终点是发病率标志物：术后出血、血细胞比容、正性肌力药的使用、重症监护病房和住院时间。分析采用意向治疗。组间差异的估计值用 95%置信区间表示。
每组（ANH 和常规护理）随机分配了 12 例小儿心脏手术患者。组间基线特征相似。ANH 的实施并未导致血液制品输注量减少（输注患者的 ANH 和常规护理之间的差异=-1.4 毫升[-29.4 至 26.6]， =.92）。次要终点在组间无差异。
在这项小儿心脏手术患者的小型试验中，作为减少血液成分治疗策略的 ANH 是安全的；然而，该研究未能显示围手术期输血或其他术后结果的减少。
