零呼气末正压对非体外循环冠状动脉搭桥手术输血率的影响：一项回顾性队列研究。

Impact of zero-positive end-expiratory pressure on blood transfusion rates in off-pump coronary artery bypass surgery: a retrospective cohort study.

作者信息

Tarao Kentaroh, Son Kyongsuk, Ishizuka Yusei, Nakagomi Atsushi, Hasegawa-Moriyama Maiko

机构信息

Department of Anesthesiology, Chiba University Hospital, Chiba, Japan.

Department of Anesthesiology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana-cho, Chuo-ku, Chiba, 260-8670, Japan.

出版信息

BMC Anesthesiol. 2024 Dec 19;24(1):461. doi: 10.1186/s12871-024-02853-7.

DOI:10.1186/s12871-024-02853-7

PMID:39695985

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11657985/

Abstract

BACKGROUND

Bleeding are common in cardiac surgery, with significant impacts on transfusion-related complications and patient prognosis. This study aimed to determine the differences in perioperative blood loss, transfusion rates, and the incidence of postoperative pulmonary complications (PPCs) with and without the use of positive end-expiratory pressure (PEEP) in patients undergoing off-pump coronary artery bypass graft surgery (OPCAB).

METHODS

This single-center, retrospective study included 106 adult patients undergoing coronary artery bypass surgery without cardiopulmonary bypass from January 2018 to March 2022. The patients were divided into two groups based on intraoperative ventilator settings: the zero-PEEP (ZEEP) group and the PEEP group. The primary outcome was the perioperative transfusion rate from the intraoperative period to postoperative 7 day. The incidence of PPCs was recorded for 1 week post-operatively. Logistic regression analysis was performed for statistical analysis.

RESULTS

The average PEEP in the PEEP group was 4.92 ± 0.42 cmHO. Multiple regression analysis indicated that lower mean airway pressure during surgery tend to associate with intraoperative lower blood loss. The intraoperative transfusion rates in the ZEEP group were significantly lower than those in the PEEP group (ZEEP:14%, PEEP 38.4%, P = 0.02). Logistic regression analysis revealed that ZEEP (adjusted odds ratio [OR] 0.13, 95% confidence interval [CI] 0.04-0.78) and Society of Thoracic Surgeons(STS) scores (adjusted OR 2.31, 95% CI 1.53-3.49) were significantly associated with a reduced requirement for perioperative transfusions. No significant difference was observed between the two groups in terms of PPCs (p = 0.824). Atelectasis was the most common complication in both groups (ZEEP: 35.7%, PEEP: 40%, P = 0.832).

CONCLUSIONS

ZEEP and STS scores were associated with significantly reduced requirement for perioperative transfusion rates during elective OPCAB surgery. However, ZEEP did not significantly affect the incidence of PPCs.

摘要

背景

心脏手术中出血很常见，对输血相关并发症和患者预后有重大影响。本研究旨在确定在非体外循环冠状动脉搭桥手术（OPCAB）患者中，使用与不使用呼气末正压（PEEP）时围手术期失血量、输血率和术后肺部并发症（PPCs）发生率的差异。

方法

这项单中心回顾性研究纳入了2018年1月至2022年3月期间106例接受非体外循环冠状动脉搭桥手术的成年患者。根据术中呼吸机设置将患者分为两组：零PEEP（ZEEP）组和PEEP组。主要结局是从术中期到术后7天的围手术期输血率。记录术后1周内PPCs的发生率。进行逻辑回归分析以进行统计分析。

结果

PEEP组的平均PEEP为4.92±0.42 cmH₂O。多元回归分析表明，手术期间较低的平均气道压力往往与术中较低的失血量相关。ZEEP组的术中输血率显著低于PEEP组（ZEEP：14%，PEEP 38.4%，P = 0.02）。逻辑回归分析显示，ZEEP（调整后的优势比[OR] 0.13，95%置信区间[CI] 0.04 - 0.78）和胸外科医师协会（STS）评分（调整后的OR 2.31，95% CI 1.53 - 3.49）与围手术期输血需求减少显著相关。两组在PPCs方面未观察到显著差异（p = 0.824）。肺不张是两组中最常见的并发症（ZEEP：35.7%，PEEP：40%，P = 0.832）。