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复杂心脏手术中的血液吸附——单中心经验

Hemoadsorption in Complex Cardiac Surgery-A Single Center Experience.

作者信息

Manohar Murali, Jawali Vivek, Neginahal Siddu, Gt Sudarshan, Muniraj Geetha, Chakravarthy Murali

机构信息

Cardiac Surgery Department, Fortis Hospital, Bengaluru 560076, India.

Cardiac Sciences Board, Fortis Hospital, Bengaluru 560076, India.

出版信息

J Clin Med. 2022 Nov 27;11(23):7005. doi: 10.3390/jcm11237005.

Abstract

(1) Background: Cardiac surgery may evoke a generalized inflammatory response, typically magnified in complex, combined, redo, and emergency procedures with long aortic cross-clamp times. Various treatment options have been introduced to help regain control over post-cardiac surgery hyper-inflammation, including hemoadsorptive immunomodulation with CytoSorb. (2) Methods: We conducted a single-center retrospective observational study of patients undergoing complex cardiac surgery. Patients intra-operatively treated with CytoSorb were compared to a control group. The primary outcome was the change in the vasoactive-inotropic score (VIS) from pre-operatively to post-operatively. (3) Results: A total of 52 patients were included in the analysis, where 23 were treated with CytoSorb (CS) and 29 without (controls). The mean VIS increase from pre-operative to post-operative values was significantly lower in the CS group compared to the control group (3.5 vs. 5.5, respectively, = 0.05). In-hospital mortality in the control group was 20.7% (6 patients) and 9.1% (2 patients) in the CS group ( = 0.26). Lactate level changes were comparable, and the median intensive care unit and hospital lengths of stay were similar between groups. (4) Conclusions: Despite notable imbalances between the groups, the signals revealed point toward better hemodynamic stability with CytoSorb hemoadsorption in complex cardiac surgery and a trend of lower mortality.

摘要

(1) 背景:心脏手术可能引发全身性炎症反应,在复杂、联合、再次手术及急诊手术且主动脉阻断时间较长的情况下,这种反应通常会加剧。已引入多种治疗方案来帮助控制心脏手术后的过度炎症,包括使用CytoSorb进行血液吸附免疫调节。(2) 方法:我们对接受复杂心脏手术的患者进行了一项单中心回顾性观察研究。将术中接受CytoSorb治疗的患者与对照组进行比较。主要结局是血管活性药物评分(VIS)从术前到术后的变化。(3) 结果:共有52例患者纳入分析,其中23例接受CytoSorb(CS)治疗,29例未接受治疗(对照组)。与对照组相比,CS组术前至术后VIS的平均增加值显著更低(分别为3.5和5.5,P = 0.05)。对照组的院内死亡率为20.7%(6例患者),CS组为9.1%(2例患者)(P = 0.26)。乳酸水平变化相当,两组间重症监护病房和住院时间中位数相似。(4) 结论:尽管两组之间存在明显失衡,但研究结果表明,在复杂心脏手术中,CytoSorb血液吸附可带来更好的血流动力学稳定性,并呈现出死亡率降低的趋势。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a06b/9735704/600d0b3b64ac/jcm-11-07005-g001.jpg

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