心内膜炎患者行瓣膜手术时体外循环期间的血液吸附：一项回顾性单中心研究
Hemoadsorption during Cardiopulmonary Bypass in Patients with Endocarditis Undergoing Valve Surgery: A Retrospective Single-Center Study.
作者信息
Santer David, Miazza Jules, Koechlin Luca, Gahl Brigitta, Rrahmani Bejtush, Hollinger Alexa, Eckstein Friedrich S, Siegemund Martin, Reuthebuch Oliver T
机构信息
Department of Cardiac Surgery, University Hospital Basel, 4031 Basel, Switzerland.
Department of Intensive Care Medicine, University Hospital Basel, 4031 Basel, Switzerland.
出版信息
J Clin Med. 2021 Feb 3;10(4):564. doi: 10.3390/jcm10040564.
BACKGROUND
Aim of this study was to evaluate the outcomes of endocarditis patients undergoing valve surgery with the Cytosorb hemoadsorption (HA) device during cardiopulmonary bypass.
METHODS
From 2009 until 2019, 241 patients had undergone valve surgery due to endocarditis at the Department of Cardiac Surgery, University Hospital of Basel. We compared patients who received HA during surgery ( = 41) versus patients without HA ( = 200), after applying inverse probability of treatment weighting.
RESULTS
In-hospital mortality, major adverse cardiac and cerebrovascular events and postoperative renal failure were similar in both groups. Demand for norepinephrine (88.4 vs. 52.8%; = 0.001), milrinone (42.2 vs. 17.2%; = 0.046), red blood cell concentrates (65.2 vs. 30.6%; = 0.003), and platelets (HA vs. Control: 36.7 vs. 9.8%; = 0.013) were higher in the HA group. In addition, a higher incidence of reoperation for bleeding (34.0 vs. 7.7 %; = 0.011), and a prolonged length of in-hospital stay (15.2 (11.8 to 19.6) vs. 9.0 (7.1 to 11.3) days; = 0.017) were observed in the HA group.
CONCLUSIONS
No benefits of HA-therapy were observed in patients with infective endocarditis undergoing valve surgery.
背景
本研究的目的是评估在体外循环期间使用Cytosorb血液吸附（HA）装置进行瓣膜手术的感染性心内膜炎患者的治疗结果。
方法
2009年至2019年期间，巴塞尔大学医院心脏外科有241例因感染性心内膜炎接受瓣膜手术的患者。在应用治疗权重的逆概率后，我们比较了手术期间接受HA治疗的患者（n = 41）与未接受HA治疗的患者（n = 200）。
结果
两组患者的住院死亡率、主要不良心脑血管事件和术后肾衰竭情况相似。HA组去甲肾上腺素需求量（88.4%对52.8%；P = 0.001）、米力农需求量（42.2%对17.2%；P = 0.046）、红细胞浓缩液需求量（65.2%对30.6%；P = 0.003）和血小板需求量（HA组对对照组：36.7%对9.8%；P = 0.013）更高。此外，HA组再次手术止血的发生率更高（34.0%对7.7%；P = 0.011），住院时间更长（15.2（11.8至19.6）天对9.0（7.1至11.3）天；P = 0.017）。
结论
在接受瓣膜手术的感染性心内膜炎患者中，未观察到HA治疗的益处。
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