Department of Anesthesiology and Operative Services, Kuopio University Hospital, Kuopio, Finland.
School of Medicine, University of Eastern Finland, Kuopio, Finland.
Perfusion. 2023 Jan;38(1):135-141. doi: 10.1177/02676591211043232. Epub 2021 Sep 3.
Compare the use of blood products and intravenous fluid management in patients scheduled for coronary artery bypass surgery and randomized to minimal invasive extracorporeal circulation (MiECC) and conventional extracorporeal circulation (CECC).
A total of 240 patients who were scheduled for their first on-pump CABG, were randomized to MiECC or CECC groups. The study period was the first 84 hours after surgery. Hemoglobin <80 g/l was used as transfusion trigger.
Red blood cell transfusions intraoperatively were given less often in the MiECC group (23.3% vs 9.2%, p = 0.005) and the total intravenous fluid intake was significantly lower in the MiECC group (3300 ml [2950-4000] vs 4800 ml [4000-5500], p < 0.001). Hemoglobin drop also was lower in the MiECC group (35.5 ± 8.9 g/l vs 50.7 ± 9 g/l, p < 0.001) as was hemoglobin drop percent (25.3 ± 6% vs 35.3 ± 5.9%, p < 0.001). Chest tube drainage output was higher in the MiECC group (645 ml [500-917.5] vs 550 ml [412.5-750], p = 0.001). Particularly, chest tube drainage in up to 600 ml category, was in benefit of CECC group (59.1% vs 40.8%, p = 0.003). ROC curve analysis showed that patients with hemoglobin level below 95 g/l upon arrival to intensive care unit was associated with increased risk of developing postoperative atrial fibrillation (POAF) (p = 0.002, auc = 0.61, cutoff <95, sensitivity = 0.47, positive predictive value = 0.64).
MiECC reduced the intraoperative need for RBC transfusion and intravenous fluids compared to the CECC group, also reducing hemoglobin drop compared to the CECC group in CABG surgery patients. Postoperative hemoglobin drop was a predictor of POAF.
比较微创体外循环（MiECC）和常规体外循环（CECC）用于拟行冠状动脉旁路移植术（CABG）患者的血液制品使用和静脉液体管理情况，并对其进行随机分组。
共有 240 名首次行体外循环下 CABG 的患者被随机分为 MiECC 组或 CECC 组。研究时间为术后 84 小时内。血红蛋白（Hb）<80g/l 时作为输血的触发指标。
MiECC 组术中红细胞输注较少（23.3% vs 9.2%，p=0.005），静脉液体总摄入量明显较低（3300ml [2950-4000] vs 4800ml [4000-5500]，p<0.001）。MiECC 组的 Hb 下降幅度也较低（35.5±8.9g/l vs 50.7±9g/l，p<0.001），Hb 下降百分比也较低（25.3±6% vs 35.3±5.9%，p<0.001）。MiECC 组的胸腔引流量较高（645ml [500-917.5] vs 550ml [412.5-750]，p=0.001）。特别是在胸腔引流量达 600ml 范围内的患者中，CECC 组更具优势（59.1% vs 40.8%，p=0.003）。ROC 曲线分析显示，患者入 ICU 时 Hb 水平低于 95g/l 与术后心房颤动（POAF）的发生风险增加相关（p=0.002，auc=0.61，截断值<95，敏感性=0.47，阳性预测值=0.64）。
与 CECC 组相比，MiECC 减少了 CABG 手术患者术中 RBC 输血和静脉液体的需求，与 CECC 组相比，Hb 下降幅度也较小。术后 Hb 下降是 POAF 的预测指标。
