Department of Intensive Care Unit, the First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, 310006, China.
Department of Medical Record, the First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, 310006, China.
BMC Cardiovasc Disord. 2023 Dec 7;23(1):598. doi: 10.1186/s12872-023-03647-4.
Extracorporeal circulation auxiliary to open heart surgery is a common procedure used to treat heart diseases. However, the optimal transfusion strategy for patients undergoing this surgery remains a subject of debate. This study aims to investigate the association between hemoglobin levels and clinical outcomes in patients undergoing extracorporeal circulation auxiliary to open heart surgery, with the ultimate goal of improving surgical success rates and enhancing patients' quality of life.
A retrospective analysis was conducted on data from the Medical Information Mart for Intensive Care IV 2.2 (MIMIC-IV 2.2) database, including 4144 patients. The patients were categorized into five groups based on their minimum hemoglobin levels during hospitalization. Baseline characteristics, clinical scores, laboratory results, and clinical outcome data were collected. Statistical analyses utilized descriptive statistics, ANOVA or Kruskal-Wallis tests, Kaplan-Meier method, and Log-rank test.
The results revealed a significant correlation between hemoglobin levels and in-hospital mortality, as well as mortality rates at 30 days, 60 days, and 180 days (p < 0.001). Patients with lower hemoglobin levels exhibited higher mortality rates. However, once hemoglobin levels exceeded 7g/dL, no significant difference in mortality rates was observed (p = 0.557). Additionally, lower hemoglobin levels were associated with prolonged hospital stay, ICU admission time, and mechanical ventilation time (p < 0.001). Furthermore, hemoglobin levels were significantly correlated with complication risk, norepinephrine dosage, and red blood cell transfusion volume (p < 0.001). However, there was no significant difference among the groups in terms of major complications, specifically sepsis (p > 0.05).
The study highlights the importance of managing hemoglobin levels in patients undergoing heart surgery with extracorporeal circulation. Hemoglobin levels can serve as valuable indicators for predicting clinical outcomes and guiding treatment decisions. Physicians should carefully consider hemoglobin levels to optimize transfusion strategies and improve postoperative patient outcomes. Further research and intervention studies are warranted to validate and implement these findings in clinical practice.
体外循环辅助心脏直视手术是治疗心脏病的常见方法。然而，这种手术患者的最佳输血策略仍存在争议。本研究旨在探讨体外循环辅助心脏直视手术后患者的血红蛋白水平与临床结局之间的关系，以期提高手术成功率，提高患者生活质量。
对 MIMIC-IV 2.2 数据库中的 4144 例患者进行回顾性分析。根据住院期间的最低血红蛋白水平，将患者分为五组。收集患者的基本特征、临床评分、实验室结果和临床结局数据。采用描述性统计、方差分析或 Kruskal-Wallis 检验、Kaplan-Meier 法和 Log-rank 检验进行统计分析。
结果显示，血红蛋白水平与住院期间死亡率以及 30 天、60 天和 180 天的死亡率显著相关（p<0.001）。血红蛋白水平较低的患者死亡率较高。然而，一旦血红蛋白水平超过 7g/dL，死亡率无显著差异（p=0.557）。此外，较低的血红蛋白水平与住院时间延长、ICU 入住时间和机械通气时间延长有关（p<0.001）。此外，血红蛋白水平与并发症风险、去甲肾上腺素用量和红细胞输注量显著相关（p<0.001）。然而，各组之间的主要并发症（特别是脓毒症）发生率无显著差异（p>0.05）。
本研究强调了管理体外循环辅助心脏直视手术患者血红蛋白水平的重要性。血红蛋白水平可作为预测临床结局和指导治疗决策的有价值指标。医生应仔细考虑血红蛋白水平，以优化输血策略，改善术后患者结局。需要进一步的研究和干预研究来验证并将这些发现应用于临床实践。
