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带与不带磷酰胆碱涂层的体外循环回路的卫生技术评估:心脏手术安全性和效率的回顾性研究

Health Technology Assessment of Cardiopulmonary Bypass Circuit with and without Phosphorylcholine Coating: A Retrospective Study on Safety and Efficiency in Cardiac Surgery.

作者信息

Condello Ignazio, Nasso Giuseppe, Scrivo Salvatore, Fiore Flavio, Speziale Giuseppe

机构信息

Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy.

出版信息

Life (Basel). 2024 Jul 6;14(7):851. doi: 10.3390/life14070851.

Abstract

BACKGROUND

Phosphorylcholine has emerged as a potential adjunctive agent in cardiopulmonary bypass (CPB) circuits. Phosphorylcholine serves as a coating for the CPB circuit, potentially enhancing biocompatibility and reducing thrombotic events. However, its impact on specific patient populations and procedural outcomes remains underexplored.

MATERIALS AND METHODS

In this retrospective study, we analyzed data from 60 patients who underwent cardiac surgery with CPB, comprising 20 cases each of coronary artery bypass grafting (CABG), mitral valve repair, and aortic valve replacement. The patient cohort was divided into two groups-30 patients whose CPB circuits were coated with phosphorylcholine (phosphorylcholine-coated group) and 30 patients who did not receive phosphorylcholine supplementation or circuit coating. Both groups underwent surgery with identical CPB circuit designs. We assessed the absence of adverse events, safety, and efficacy parameters, including blood loss, clotting, and the structural integrity of the CPB circuit. Additionally, we measured changes in mean albumin levels (g/dL), mean platelet counts (×10/L), and antithrombin III (ATIII) levels before and after CPB.

RESULTS

The retrospective analysis revealed an absence of adverse events in both groups. In the phosphorylcholine-coated group compared to the non-phosphorylcholine-coated group, there was a notable difference in the delta change in mean albumin levels (0.87 ± 0.1 vs. 1.65 ± 0.2 g/dL, -value 0.021), mean platelet counts (42.251 ± 0.121 vs. 54.21 ± 0.194 × 10/L, -value 0.049), and ATIII levels (16.85 ± 0.2 vs. 31.21 ± 0.3 -value 0.017). There was a notable reduction in the perioperative consumption of human complex units after CPB (3 vs. 12, -value 0.019).

CONCLUSIONS

Both groups, phosphorylcholine and non-phosphorylcholine, demonstrated the absence of adverse events and that the systems are safe for iatrogenic complication. Our findings suggest that the use of phosphorylcholine coating on the CPB circuit, in the absence of supplementary phosphorylcholine, in cardiac surgery is associated with favorable changes in mean albumin levels, mean platelet counts, and ATIII levels. Further research is warranted to elucidate the full extent of phosphorylcholine's impact on patient outcomes and CPB circuit performance.

摘要

背景

磷酰胆碱已成为体外循环(CPB)回路中一种潜在的辅助剂。磷酰胆碱可作为CPB回路的涂层,有可能增强生物相容性并减少血栓形成事件。然而,其对特定患者群体和手术结果的影响仍未得到充分研究。

材料与方法

在这项回顾性研究中,我们分析了60例行CPB心脏手术患者的数据,包括冠状动脉旁路移植术(CABG)、二尖瓣修复术和主动脉瓣置换术各20例。患者队列分为两组,30例患者的CPB回路涂有磷酰胆碱(磷酰胆碱涂层组),30例患者未接受磷酰胆碱补充或回路涂层。两组均采用相同的CPB回路设计进行手术。我们评估了不良事件的有无、安全性和疗效参数,包括失血、凝血以及CPB回路的结构完整性。此外,我们测量了CPB前后平均白蛋白水平(g/dL)、平均血小板计数(×10/L)和抗凝血酶III(ATIII)水平的变化。

结果

回顾性分析显示两组均无不良事件。与未涂磷酰胆碱组相比,磷酰胆碱涂层组在平均白蛋白水平的变化量(0.87±0.1 vs. 1.65±0.2 g/dL,P值0.021)、平均血小板计数(42.251±0.121 vs. 54.21±0.194×10/L,P值0.049)和ATIII水平(16.85±0.2 vs. 31.21±0.3,P值0.017)方面存在显著差异。CPB后围手术期人凝血因子复合物单位的消耗量显著减少(3 vs. 12,P值0.019)。

结论

磷酰胆碱组和未涂磷酰胆碱组均未出现不良事件,且该系统对医源性并发症是安全的。我们的研究结果表明,在心脏手术中,CPB回路使用磷酰胆碱涂层(无磷酰胆碱补充)与平均白蛋白水平平均血小板计数和ATIII水平的有利变化相关。有必要进一步研究以阐明磷酰胆碱对患者结局和CPB回路性能影响的全貌。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6435/11277647/f8c83c1f5a41/life-14-00851-g001.jpg

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