Ștefan Mihai, Tomescu Dana, Predoi Cornelia, Goicea Raluca, Perescu Mihai, Popescu Mihai, Dorobanțu Dan, Droc Gabriela, Andrei Ștefan, Știru Ovidiu, Bubenek Turconi Șerban-Ion, Filipescu Daniela
2nd Department of Anaesthesiology and Intensive Care, "Prof Dr CC Iliescu" Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania.
Discipline of Anaesthesiology and Intensive Care, "Carol Davila" University of Medicine and Pharmacy, 419291 Bucharest, Romania.
J Cardiovasc Dev Dis. 2023 Jun 22;10(7):266. doi: 10.3390/jcdd10070266.
The implementation of Patient Blood Management (PBM) in cardiac surgery has been shown to be effective in reducing blood transfusions and associated complications, as well as improving patient outcomes. Despite the potential benefits of PBM in cardiac surgery, there are several barriers to its successful implementation. The main objectives of this study were to ascertain the impact of the national Romanian PBM recommendations on allogeneic blood product transfusion in cardiac surgery and identify predictors of perioperative packed red blood cell transfusion. As part of the Romanian national pilot programme of PBM, we performed a single-centre, retrospective study in a tertiary centre of cardiovascular surgery, including patients from two time periods, before and after the implementation of the national recommendations. Using coarsened exact matching, from a total of 1174 patients, 157 patients from the before group were matched to 169 patients in the after group. Finally, we built a multivariate regression model from the entire cohort to analyse independent predictors of PRBC transfusion in the perioperative period. Although there was a trend towards a lower proportion of patients requiring PRBC transfusion in the "after" group compared to the "before" group (44.9%vs. 50.3%), it was not statistically significant. There was a significant difference between the "after" group and the "before" group in terms of fresh-frozen plasma (FFP) transfusion rates, with a lower percentage of patients requiring FFP transfusion in the "after" group compared to "before" (14.2%, vs. 22.9%, = 0.04). This difference was also seen in the total perioperative FFP transfusion (mean transfusion 0.7 units in the "before" group, SD 1.73 vs. 0.38 units in the "after" group, SD 1.05, = 0.04). In the multivariate regression analysis, age > 64 years (OR 1.652, 95% CI 1.17-2.331, = 0.004), female sex (OR 2.404, 95% CI 1.655-3.492, < 0.001), surgery time (OR 1.295, 95% CI 1.126-1.488, < 0.001), Hb < 13 g/dl (OR 3.611, 95% CI 2.528-5.158, < 0.001), re-exploration for bleeding (OR 3.988, 95% CI 1.248-12.738, = 0.020), viscoelastic test use (OR 2.18, 95% CI 1.34-3.544, < 0.001), FFP transfusion (OR 4.023, 95% CI 2.426-6.671, < 0.001), and use of a standardized pretransfusion checklist (OR 8.875, 95% CI 5.496-14.332, < 0.001) remained significantly associated with PRBC transfusion. The use of a preoperative standardized haemostasis questionnaire was independently associated with a decreased risk of perioperative PRBC transfusion (0.565, 95% CI 0.371-0.861, = 0.008). Implementation of national PBM recommendations led to a reduction in FFP transfusion in a cardiac surgery centre. The use of a preoperative standardized haemostasis questionnaire is an independent predictor of a lower risk for PRBC transfusion in this setting.
心脏手术中实施患者血液管理（PBM）已被证明在减少输血及相关并发症以及改善患者预后方面是有效的。尽管PBM在心脏手术中有潜在益处，但其成功实施存在若干障碍。本研究的主要目的是确定罗马尼亚国家PBM建议对心脏手术中异体血制品输血的影响，并确定围手术期浓缩红细胞输血的预测因素。作为罗马尼亚国家PBM试点项目的一部分，我们在一家心血管外科三级中心进行了一项单中心回顾性研究，纳入了国家建议实施前后两个时间段的患者。使用精确匹配法，在总共1174例患者中，将157例术前组患者与169例术后组患者进行匹配。最后，我们从整个队列构建了一个多变量回归模型，以分析围手术期PRBC输血的独立预测因素。尽管与“术前”组相比，“术后”组中需要PRBC输血的患者比例有下降趋势（44.9%对50.3%），但差异无统计学意义。“术后”组与“术前”组在新鲜冰冻血浆（FFP）输血率方面存在显著差异，“术后”组中需要FFP输血的患者百分比低于“术前”组（14.2%对22.9%，P = 0.04）。围手术期FFP总输血量也有此差异（“术前”组平均输血0.7单位，标准差1.73；“术后”组为0.38单位，标准差1.05，P = 0.04）。在多变量回归分析中，年龄>64岁（OR 1.652，95%CI 1.17 - 2.331，P = 0.004）、女性（OR 2.404，95%CI 1.655 - 3.492，P < 0.001）、手术时间（OR 1.295，95%CI 1.126 - 1.488，P < 0.001）、血红蛋白<13 g/dl（OR 3.611，95%CI 2.528 - 5.158，P < 0.001）、再次手术止血（OR 3.988，95%CI 1.248 - 12.738，P = 0.020）、使用粘弹性试验（OR 2.18，95%CI 1.34 - 3.544，P < 0.001）、FFP输血（OR 4.023，95%CI 2.426 - 6.671，P < 0.001）以及使用标准化输血前检查表（OR 8.875，95%CI 5.496 - 14.332，P < 0.001）仍与PRBC输血显著相关。使用术前标准化止血问卷与围手术期PRBC输血风险降低独立相关（0.565，95%CI 0.371 - 0.861，P = 0.008）。国家PBM建议的实施导致心脏手术中心FFP输血减少。在这种情况下，使用术前标准化止血问卷是PRBC输血风险较低的独立预测因素。
