肝素敏感指数与中国择期不停跳冠状动脉旁路移植术患者术后失血的相关性：单中心回顾性研究。
The association between heparin sensitivity index and postoperative blood loss in Chinese patients undergoing elective off-pump coronary artery bypass grafting: a single center retrospective study.
机构信息
Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510006, China.
Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, Xicheng District, Beijing, 100037, China.
出版信息
J Cardiothorac Surg. 2024 Jul 8;19(1):426. doi: 10.1186/s13019-024-02966-7.
BACKGROUND
The heparin sensitivity index (HSI) is closely associated with perioperative ischemic events and increased blood loss in cardiac surgery. Previous studies have produced conflicting results. Therefore, this study aimed to investigate the relationship between HSI and postoperative blood loss specifically in Chinese patients undergoing elective off-pump coronary artery bypass grafting (OPCAB).
METHODS
Patients underwent OPCAB between March 2021 and July 2022 were retrospectively included. Enrolled patients were classified into Low-HSI (HSI; HSI < 1.3) and Normal-HSI (HSI; HSI ≥ 1.3) groups. HSI = [(activated clotting time (ACT) after heparin) - (baseline ACT)] / [loading dose of heparin (IU/kg)]. Primary outcome included postoperative blood loss at 24 h. Secondary outcomes were total postoperative blood loss, transfusion requirement of red blood cell (RBC), fresh frozen plasma (FFP), platelet concentrates (PC), and other complications.
RESULTS
We retrospectively analyzed 303 Chinese OPCAB patients. HSI group had higher preoperative platelet (PLT) count (221 × 10/L vs. 202 × 10/L; P = 0.041) and platelet crit (PCT) value (0.23% vs. 0.22%; P = 0.040) compared to HSI group. Two groups showed no significant differences in postoperative blood loss at 24 h (460 mL vs. 470 mL; P = 0.252), total blood loss (920 mL vs. 980 mL; P = 0.063), RBC transfusion requirement (3.4% vs. 3.1%; P = 1.000), FFP transfusion requirement (3.4% vs. 6.2%; P = 0.380), and other complications. Preoperative high PLT count was associated with low intraoperative HSI value (odds ratio: 1.006; 95% confidence interval: 1.002, 1.011; P = 0.008).
CONCLUSIONS
Intraoperative HSI value was not associated with postoperative blood loss in Chinese patients undergoing OPCAB. Preoperative high PLT count was an independent predictor of low intraoperative HSI value.
背景
肝素敏感性指数（HSI）与心脏手术围手术期缺血事件和失血增加密切相关。既往研究结果存在争议。因此，本研究旨在探讨 HSI 与术后失血的关系，特别是在中国行择期非体外循环冠状动脉旁路移植术（OPCAB）的患者中。
方法
回顾性纳入 2021 年 3 月至 2022 年 7 月期间行 OPCAB 的患者。入组患者分为低 HSI（HSI；HSI<1.3）和正常 HSI（HSI；HSI≥1.3）组。HSI=（肝素后活化凝血时间（ACT）-基础 ACT）/（肝素负荷剂量（IU/kg））。主要结局为术后 24 小时的术后出血量。次要结局为总术后出血量、红细胞（RBC）、新鲜冷冻血浆（FFP）、血小板浓缩物（PC）的输血需求以及其他并发症。
结果
我们回顾性分析了 303 例中国 OPCAB 患者。HSI 组术前血小板（PLT）计数（221×10/L 比 202×10/L；P=0.041）和血小板crit（PCT）值（0.23%比 0.22%；P=0.040）均高于 HSI 组。两组在术后 24 小时出血量（460 mL 比 470 mL；P=0.252）、总出血量（920 mL 比 980 mL；P=0.063）、RBC 输血需求（3.4%比 3.1%；P=1.000）、FFP 输血需求（3.4%比 6.2%；P=0.380）和其他并发症方面无显著差异。术前高 PLT 计数与术中低 HSI 值相关（比值比：1.006；95%置信区间：1.002，1.011；P=0.008）。
结论
在中国行 OPCAB 的患者中，术中 HSI 值与术后出血量无关。术前高 PLT 计数是术中低 HSI 值的独立预测因素。
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