Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, P.R. China.
Department of Emergency, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, P.R. China.
Ann Med. 2023;55(2):2246996. doi: 10.1080/07853890.2023.2246996.
Cardiopulmonary bypass (CPB) is frequently employed for cardiac surgery, and selecting a suitable priming fluid is a prerequisite for CPB. Currently, the commonly used priming fluids in clinics are classified as crystalloids and colloids, including balanced crystalloids, albumin, dextran, gelatin and hydroxyethyl starch (HES). This network meta-analysis compared the effects of eight fluids used during CPB in adults to determine optimal priming fluid during CPB surgery.
Randomised controlled trials assessing priming fluids for CPB in adult cardiac surgery published before 13 April 2023 were searched across Ovid MEDLINE(R) ALL, OVID EMbase, and Cochrane Central Register of Controlled Trials. Various priming fluids were classified into eight categories, including balanced crystalloids, 0.9% NaCl, iso-oncotic human albumin, hyperoncotic human albumin, HES with molecular weight 130k, HES with molecular weight 200k, gelatin and dextran.
The NMA of platelet counts revealed no significant differences in any result. In direct comparison results, only the comparison of HES with molecular weight 130k vs. gelatin (standard mean difference = -0.40, 95% confidence interval [95%CI: -0.63, -0.16) revealed a significant difference. According to the SUCRA, balanced crystalloids had the highest platelet count, followed by gelatin, and HES with a molecular weight of 130k had the lowest platelet, followed by HES with a molecular weight of 200k.
Patients using dextran have a low mortality rate and a short mean CPB time, the use of balanced crystalloids is beneficial in terms of platelet count, and HES with molecular weight 130k is beneficial for postoperative urine volume at 24h. However, all priming fluids have pros and cons quite, and the optimal choice of priming fluids remains unsupported by current evidences. When performing CPB surgery, the type of priming fluid should be selected according to the actual situation in CPB for adult cardiac surgery.
体外循环（CPB）常用于心脏手术，选择合适的预充液是 CPB 的前提。目前，临床常用的预充液分为晶体液和胶体液，包括平衡晶体液、白蛋白、右旋糖酐、明胶和羟乙基淀粉（HES）。本网络荟萃分析比较了成人 CPB 中使用的八种液体的效果，以确定 CPB 手术中最佳的预充液。
检索了截至 2023 年 4 月 13 日在 Ovid MEDLINE（R）ALL、Ovid EMbase 和 Cochrane 对照试验中心注册库发表的评估成人心脏手术 CPB 预充液的随机对照试验。各种预充液分为八类，包括平衡晶体液、0.9%NaCl、等渗人白蛋白、高渗人白蛋白、分子量 130k 的 HES、分子量 200k 的 HES、明胶和右旋糖酐。
血小板计数的 NMA 显示任何结果均无显著差异。在直接比较结果中，只有分子量 130k 的 HES 与明胶的比较（标准均数差=-0.40，95%置信区间[95%CI：-0.63，-0.16]）显示出显著差异。根据 SUCRA，平衡晶体液的血小板计数最高，其次是明胶，分子量 130k 的 HES 的血小板计数最低，其次是分子量 200k 的 HES。
使用右旋糖酐的患者死亡率较低，平均 CPB 时间较短，使用平衡晶体液有利于血小板计数，分子量 130k 的 HES 有利于术后 24 小时尿量。然而，所有预充液都有优缺点，目前的证据并不支持最佳预充液的选择。在进行 CPB 手术时，应根据成人心脏手术 CPB 的实际情况选择预充液类型。
