Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Transfusion Medicine, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
J Cardiothorac Vasc Anesth. 2021 Feb;35(2):421-428. doi: 10.1053/j.jvca.2020.07.009. Epub 2020 Jul 6.
To investigate the association of adenosine diphosphate (ADP)-induced platelet maximum amplitude (MA) with postoperative bleeding and blood product transfusions in patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB).
This single-center observational study recruited 200 patients who underwent elective, first-time, isolated CABG with CPB. A rapid thromboelastography with platelet mapping test was conducted for all patients before the surgery. Patients were categorized by the preoperative MA into ≤50 mm (MA ≤50 group [n = 87]) and MA >50 mm (MA >50 group [n = 113]). The primary outcome was postoperative bleeding at 6 and 24 hours as measured by chest tube drainage volume. The perioperative blood product transfusions, postoperative complications, postoperative time course, and in-hospital mortality also were evaluated.
University hospital.
Adult patients scheduled to undergo isolated primary CABG with CPB.
None.
The study included 200 patients who underwent CABG with CPB. MA was >50 mm in 113 (56.5%) patients (MA >50 group). Compared with the MA >50 group, the postoperative chest tube drainage volume at 6 and 24 hours was significantly greater in the patients with MA ≤50 mm (476.90 ± 156.36 mL v 403.36 ± 133.24 mL; p < 0.001 and 935.86 ± 318.43 mL v 667.21 ± 222.75 mL; p < 0.001, respectively). The consumption of blood products in patients with MA ≤50 mm was significantly more than those with MA >50 mm. The durations of intensive care unit stay and length of postoperative hospital stay were markedly longer in the MA ≤50 group than in the MA >50 group (p = 0.001 and p = 0.005; respectively). There were no significant differences in adverse outcomes between the 2 groups except for the postoperative atrial fibrillation, which occurred more in the MA ≤50 group than in the MA >50 group (8.05% v 1.77%; p = 0.043). MA (area under the receiver operating characteristic curve of 0.767; p < 0.001) was demonstrated to have significant ability to predict bleeding tendency, with a sensitivity of 76.2% and a specificity of 69.0%.
Preoperative MA may play a potential role in the prediction of postoperative bleeding and allogeneic blood transfusions and guide clinicians in perioperative management of patients undergoing CABG with CPB.
研究腺苷二磷酸（ADP）诱导的血小板最大振幅（MA）与体外循环（CPB）下冠状动脉旁路移植术（CABG）患者术后出血和血液制品输注的关系。
这项单中心观察性研究招募了 200 名接受择期、首次、单纯 CABG 加 CPB 的患者。所有患者均在术前进行快速血栓弹力图和血小板图谱检测。根据术前 MA 将患者分为≤50mm（MA≤50 组[n=87]）和 MA＞50mm（MA＞50 组[n=113]）。主要结局是通过胸腔引流管引流量测量术后 6 小时和 24 小时的出血。还评估了围手术期血液制品输注、术后并发症、术后时间进程和住院死亡率。
大学医院。
计划接受 CPB 下单纯 CABG 的成年患者。
无。
该研究纳入了 200 名接受 CPB 下 CABG 的患者。113 名（56.5%）患者的 MA＞50mm（MA＞50 组）。与 MA＞50 组相比，MA≤50mm 组患者术后 6 小时和 24 小时的胸腔引流管引流量显著增加（476.90±156.36ml 比 403.36±133.24ml；p＜0.001 和 935.86±318.43ml 比 667.21±222.75ml；p＜0.001）。MA≤50mm 组患者血液制品的消耗明显多于 MA＞50mm 组。MA≤50mm 组患者的重症监护病房停留时间和术后住院时间明显长于 MA＞50mm 组（p=0.001 和 p=0.005；分别）。两组除术后心房颤动外，其他不良结局无显著差异（8.05%比 1.77%；p=0.043）。MA（受试者工作特征曲线下面积为 0.767；p＜0.001）显示出对出血倾向具有显著的预测能力，敏感性为 76.2%，特异性为 69.0%。
术前 MA 可能在预测术后出血和同种异体输血方面发挥潜在作用，并指导 CPB 下 CABG 患者围手术期管理。
