Métras D, Coulibaly A O, Ouattara K, Longechaud A, Millet P, Chauvet J
Thorax. 1982 Jul;37(7):486-91. doi: 10.1136/thx.37.7.486.
Fifteen cases of open-heart surgery in patients with sickle-cell haemoglobinopathies are reported; 13 had sickle-cell trait, one had SC haemoglobinopathy, and one had β-thalassaemia sickle-cell disease. All patients except one were operated on with moderate hypothermia, aortic cross-clamping, topical hypothermia, and cold cardioplegia. A bloodless priming solution was used in nine patients and five did not receive any blood throughout their hospital stay. Arterial and venous blood gas analysis and a search for sickle cells and haemolysis were carried out during and after cardiopulmonary bypass. The data were compared with the findings in a group of 29 patients without haemoglobinopathy operated on without blood transfusion. Two patients died from low cardiac output, unrelated to the haemoglobinopathy. All other patients recovered uneventfully. Sickling occurred during and after bypass in only one case, and the percentage of sickle cells was considerably lower during and after surgery than before. Haemolysis occurred only once during cardiopulmonary bypass and twice after surgery (the two deaths from low cardiac output). There was no acidosis or hypoxia. There was no difference in the loss of haemoglobin between the 13 survivors and the control group. Our data suggest that adequate oxygenation and avoidance of acidosis and dehydration during surgery are important. On the other hand, we do not believe that preoperative transfusion or exchange transfusion, a blood prime, normothermia, and the avoidance of aortic cross-clamping or topical hypothermia are essential precautions. We believe that transfusion should be used during cardiopulmonary bypass only for severely anaemic patients. The technique used in our cases adds to the safety of the procedure and improves the protection of the myocardium.
报告了15例镰状细胞血红蛋白病患者的心脏直视手术情况；其中13例为镰状细胞性状，1例为SC血红蛋白病，1例为β地中海贫血镰状细胞病。除1例患者外，所有患者均在中度低温、主动脉交叉钳夹、局部低温和冷心脏停搏液的条件下进行手术。9例患者使用了无血预充液，5例患者在整个住院期间未接受任何血液制品。在体外循环期间和之后进行了动脉和静脉血气分析，并检查了镰状细胞和溶血情况。将这些数据与一组29例未患血红蛋白病且未输血进行手术的患者的结果进行了比较。2例患者死于低心输出量，与血红蛋白病无关。所有其他患者均顺利康复。仅1例患者在体外循环期间和之后出现镰状化，手术期间和之后镰状细胞的百分比明显低于术前。溶血仅在体外循环期间发生1次，术后发生2次（2例死于低心输出量）。没有酸中毒或缺氧情况。13例幸存者与对照组之间血红蛋白的损失没有差异。我们的数据表明，手术期间充分的氧合以及避免酸中毒和脱水很重要。另一方面，我们认为术前输血或换血输血、血液预充、常温以及避免主动脉交叉钳夹或局部低温并非必要的预防措施。我们认为仅在体外循环期间对严重贫血患者使用输血。我们病例中所采用的技术增加了手术的安全性并改善了对心肌的保护。
