Kiser Kelsie, Sandhu Harleen, Miller Charles C, Holt David
McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas; Memorial Hermann Hospital, Texas Medical Center, Houston, Texas; and University of Nebraska Medical Center, Omaha, Nebraska.
J Extra Corpor Technol. 2020 Dec;52(4):295-302. doi: 10.1182/ject-2000037.
The use of cardiopulmonary bypass (CPB) contributes significantly to intraoperative anemia. The use of a prescriptive circuit that is tailored to the patient size could significantly reduce priming volumes, resulting in less hemodilution. The purpose of this study was to determine whether a prescriptive circuit resulted in decreased hemodilution, reduced blood product usage, and improved outcomes. In total, 204 patients prospectively received the prescriptive protocol between March 2019 and November 2019. This protocol was composed of three circuit sizes: small [body surface area (BSA) ≤ 1.85 m], medium (BSA 1.86-2.30 m), and large (BSA ≥ 2.31 m). Data for CPB and post-bypass transfusions were collected, along with postoperative outcomes. These patients were then 1:2 propensity score matched to 401 patients who were retrospectively reviewed who had undergone cardiac surgery using a one-sized CPB circuit. The prescriptive protocol cohort had more patients with renal disease, whereas the conventional cohort had more history of hypertension. Intraoperative results show the prescriptive circuit had lower mean prime volume and total prime volume after reverse autologous prime (1,084 mL vs. 1,798 mL, < .0001; 725 mL vs. 1,181 mL, < .0001). Ultrafiltration was higher in the prescriptive group (872 vs. 645 mL, < .0001), which likely balanced the increased use of del Nido cardioplegia in the prescriptive group (1,295 vs. 377 mL, < .0001). The drop in hematocrit (HCT) from baseline was less in the prescriptive group (15.1 ± 4.91 vs. 16.2 ± 4.88, = .0149), whereas the postoperative HCT was higher (32.79 ± 4.88 vs. 31.68 ± 4.99, = .0069). Transfusion of packed red cells did not change between the two groups. Implementation of a prescriptive circuit did not reduce on-bypass or intraoperative blood product usage. However, there was a significant reduction in on-bypass hemodilution and increased postoperative HCT.
体外循环（CPB）的使用是术中贫血的重要原因。使用根据患者体型定制的特定回路可显著减少预充量，从而减少血液稀释。本研究的目的是确定特定回路是否能减少血液稀释、减少血制品使用并改善预后。2019年3月至2019年11月期间，共有204例患者前瞻性地接受了特定方案。该方案包括三种回路尺寸：小[体表面积（BSA）≤1.85平方米]、中（BSA 1.86 - 2.30平方米）和大（BSA≥2.31平方米）。收集了CPB和体外循环后输血的数据以及术后结果。然后将这些患者与401例回顾性研究的患者进行1:2倾向评分匹配，这些患者使用单一尺寸的CPB回路进行了心脏手术。特定方案队列中肾病患者较多，而传统队列中高血压病史患者较多。术中结果显示，特定回路在自体预充逆转后的平均预充量和总预充量较低（1084毫升对1798毫升，P <.0001；725毫升对1181毫升，P <.0001）。特定组的超滤量较高（872对645毫升，P <.0001），这可能平衡了特定组中del Nido心脏停搏液使用的增加（1295对377毫升，P <.0001）。特定组中血细胞比容（HCT）相对于基线的下降较少（15.1±4.91对16.2±4.88，P =.0149），而术后HCT较高（32.79±4.88对31.68±4.99，P =.0069）。两组之间浓缩红细胞的输注没有变化。实施特定回路并没有减少体外循环或术中血制品的使用。然而，体外循环血液稀释显著减少，术后HCT增加。
