Savorgnan Fabio, Bhat Priya N, Checchia Paul A, Acosta Sebastian, Tume Sebastian C, Lasa Javier J, Asadourian Vicken, Achuff Barbara-Jo, Flores Saul, Ahmed Mubasheer, Crouthamel Daniel I, Loomba Rohit S, Bronicki Ronald A
Department of Pediatrics, Divisions of Critical Care Medicine and Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX.
Department of Pediatrics, Division of Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX.
Crit Care Explor. 2021 May 20;3(5):e0417. doi: 10.1097/CCE.0000000000000417. eCollection 2021 May.
The transfusion of stored RBCs decreases nitric oxide bioavailability, which may have an adverse effect on vascular function. We assessed the effects of RBC transfusion on coronary vascular function by evaluating the relationship between myocardial oxygen delivery and demand as evidenced by ST segment variability.
Retrospective case-control study.
Nine-hundred seventy-three-bed pediatric hospital with a 54-bed cardiovascular ICU.
Seventy-three neonates with hypoplastic left heart syndrome following the Norwood procedure, 38 with a Blalock-Taussig shunt and 35 with a right ventricle to pulmonary artery shunt.
RBC transfusion.
High-frequency physiologic data were captured 30 minutes prior to the initiation of (baseline) and during the 120 minutes of the transfusion. A rate pressure product was calculated for each subject and used as an indicator of myocardial oxygen demand. Electrocardiogram leads (aVL, V1, II) were used to construct a 3D ST segment vector to assess ST segment variability and functioned as a surrogate indicator of myocardial ischemia. One-hundred thirty-eight transfusions occurred in the Blalock-Taussig shunt group and 139 in the right ventricle to pulmonary artery shunt group. There was no significant change in the rate pressure product for either group; however, ST segment variability progressively increased for the entire cohort during the transfusion, becoming statistically significant by the end of the transfusion. Upon subgroup analysis, this finding was noted with statistical significance in the Blalock-Taussig shunt group and trending toward significance in the right ventricle to pulmonary artery shunt group.
We found a significant increase in the ST segment variability and evidence of myocardial ischemia temporally associated with RBC transfusions in neonates following the Norwood procedure, specifically among those in the Blalock-Taussig shunt group, which may impact immediate and long-term outcomes.
输注储存的红细胞会降低一氧化氮生物利用度，这可能对血管功能产生不利影响。我们通过评估心肌氧输送与需求之间的关系（以ST段变异性为证据）来评估红细胞输注对冠状动脉血管功能的影响。
回顾性病例对照研究。
拥有973张床位的儿科医院，设有54张床位的心血管重症监护病房。
73例接受诺伍德手术后患有左心发育不全综合征的新生儿，38例接受布莱洛克-陶西格分流术，35例接受右心室至肺动脉分流术。
红细胞输注。
在输注开始前30分钟（基线）和输注的120分钟内采集高频生理数据。计算每个受试者的心率血压乘积，并将其用作心肌氧需求的指标。使用心电图导联（aVL、V1、II）构建三维ST段向量以评估ST段变异性，并用作心肌缺血的替代指标。布莱洛克-陶西格分流术组发生了138次输血，右心室至肺动脉分流术组发生了139次输血。两组的心率血压乘积均无显著变化；然而，在输注期间，整个队列的ST段变异性逐渐增加，在输注结束时具有统计学意义。亚组分析显示，这一发现在布莱洛克-陶西格分流术组具有统计学意义，在右心室至肺动脉分流术组有显著趋势。
我们发现诺伍德手术后的新生儿在红细胞输注后，ST段变异性显著增加，并有心肌缺血的证据，特别是在布莱洛克-陶西格分流术组中，这可能会影响近期和长期预后。
