Spiess B D, Gillies B S, Chandler W, Verrier E
Department of Anesthesiology, University of Washington, Seattle 98195, USA.
J Cardiothorac Vasc Anesth. 1995 Apr;9(2):168-73. doi: 10.1016/S1053-0770(05)80189-2.
A retrospective study was performed to determine the impact of a coagulation and transfusion management program on blood utilization in 1,079 sequential patients for myocardial revascularization and open ventricle or combined procedures. Four hundred and eighty-eight patients (group 1) before, and 591 patients (group 2) after institution of thromboelastography (TEG)-guided coagulation were studied and compared for transfusion requirements, donor exposure, and the incidence of reoperation for hemorrhage. Group 2 patients had a significantly lower incidence of overall transfusion (78.5% v 86.3%) during hospitalization and in total transfusion in the operating room (57.9% v 66.4%). The incidence of each transfusion subtype was also significantly lower in group 2 patients. Actual total median donor exposure was 8 in group 1 patients and 6 exposures in group 2 patients. Mediastinal reexploration for hemorrhage was 5.7% before institution of TEG-based coagulation monitoring and 1.5% in TEG-monitored patients. Use of TEG monitoring before reexploration has decreased the cost and potential risk for patients undergoing CABG surgery.
开展了一项回顾性研究，以确定凝血与输血管理方案对1079例连续接受心肌血运重建术、开放性心室手术或联合手术患者的用血情况的影响。研究并比较了实施血栓弹力图（TEG）引导凝血前的488例患者（第1组）和实施后591例患者（第2组）的输血需求、供血者暴露情况及再次手术止血的发生率。第2组患者住院期间的总体输血发生率（78.5%对86.3%）及手术室总输血发生率（57.9%对66.4%）显著更低。第2组患者各输血亚型的发生率也显著更低。第1组患者实际供血者暴露总数中位数为8次，第2组患者为6次。在基于TEG的凝血监测实施前，因出血进行纵隔再次探查的比例为5.7%，在TEG监测患者中为1.5%。在再次探查前使用TEG监测降低了接受冠状动脉旁路移植术（CABG）手术患者的费用及潜在风险。
