Department of Cardiothoracic Surgery, KK Women's and Children's Hospital, Singapore, Singapore.
Department of Biostatistics, National Heart Centre Singapore, Singapore, Singapore.
Interact Cardiovasc Thorac Surg. 2021 May 10;32(5):671-682. doi: 10.1093/icvts/ivaa330.
Cardiopulmonary bypass in cardiac surgery has been associated with several deleterious effects including haemodilution and systemic inflammation. Modified ultrafiltration (MUF) has been well established in paediatric cardiac surgery in counteracting postperfusion syndrome. However, MUF is less commonly used in adult cardiac surgery. In this meta-analysis, we compared clinical outcomes in adult patients who underwent cardiopulmonary bypass with and without MUF.
Electronic searches were performed using Pubmed, Ovid Medline, EMBASE and the Cochrane Library until April 2020. Selection criteria were randomized studies of adult cardiac surgery patients comparing MUF versus no MUF. Primary outcomes were postoperative mortality, haematocrit, blood transfusion, chest tube drainage, duration of intensive care unit (ICU) stay and duration of mechanical ventilation.
Thirteen randomized controlled trials were included, comprising 626 patients in the MUF group, and 610 patients in the control (no-MUF) group. There was a significantly improved postoperative haematocrit [mean difference 2.70, 95% confidence interval (CI) 0.68-4.73, P = 0.009], lower chest tube drainage (mean difference -105 ml, 95% CI -202 to -7 ml, P = 0.032), lower postoperative blood transfusion rate (mean difference -0.73 units, 95% CI -0.98 to -0.47 units, P < 0.0001) and shorter duration of ICU stay (mean difference -0.13 days, 95% CI -0.27 to -0.00 days, P = 0.048) in the MUF group. There was no difference in ventilation time (mean difference -0.47 h, 95% CI -2.05 to 1.12 h, P = 0.56) or mortality rates (odds ratio 0.62, 95% CI 0.28-1.33, P = 0.22). There were no reported complications associated with MUF.
MUF is a safe and feasible option in adult cardiac patients, with significant benefits including improved postoperative haematocrit, as well as reduced postoperative chest tube bleeding, transfusion requirements and duration of ICU stay.
体外循环在心脏手术中与多种有害影响有关，包括血液稀释和全身炎症。改良超滤（MUF）在儿科心脏手术中已被广泛应用于对抗后灌注综合征。然而，MUF 在成人心脏手术中使用较少。在这项荟萃分析中，我们比较了接受和不接受 MUF 的成人心脏手术患者的临床结局。
使用 Pubmed、Ovid Medline、EMBASE 和 Cochrane 图书馆进行电子检索，检索时间截至 2020 年 4 月。选择标准是比较 MUF 与不进行 MUF 的成人心脏手术患者的随机研究。主要结局是术后死亡率、血细胞比容、输血、胸腔引流管引流量、重症监护病房（ICU）住院时间和机械通气时间。
共纳入 13 项随机对照试验，MUF 组 626 例，对照组（无 MUF 组）610 例。术后血细胞比容显著改善[平均差异 2.70，95%置信区间（CI）0.68-4.73，P=0.009]，胸腔引流管引流量减少[平均差异-105ml，95%CI-202 至-7ml，P=0.032]，术后输血率降低[平均差异-0.73 单位，95%CI-0.98 至-0.47 单位，P<0.0001]，ICU 住院时间缩短[平均差异-0.13 天，95%CI-0.27 至-0.00 天，P=0.048]。MUF 组的通气时间无差异[平均差异-0.47 小时，95%CI-2.05 至 1.12 小时，P=0.56]或死亡率[比值比 0.62，95%CI 0.28-1.33，P=0.22]。没有报道与 MUF 相关的并发症。
MUF 是成人心脏患者的一种安全可行的选择，具有显著益处，包括改善术后血细胞比容，以及减少术后胸腔引流出血、输血需求和 ICU 住院时间。
