Sutton R G, Kratz J M, Spinale F G, Crawford F A
Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston.
Ann Thorac Surg. 1993 Oct;56(4):938-43. doi: 10.1016/0003-4975(93)90360-t.
The return of extracorporeal circuit blood at the termination of cardiopulmonary bypass is an important feature of blood conservation during open heart procedures. However, the relative benefits and disadvantages of different circuit blood salvage methods remain unclear. Accordingly, the purpose of this study was to examine whether quantifiable differences exist between three different circuit blood-salvaging techniques: direct infusion, centrifugation, and ultrafiltration. Sixty patients with very similar preoperative characteristics were randomly assigned to each of the three groups, and blood coagulation screens, plasma profiles, and respiratory function were determined at 20 minutes and at 6 and 18 hours after cardiopulmonary bypass. Early after cardiopulmonary bypass (20 minutes), the plasma colloid osmotic pressure and fibrinogen and platelet concentrations were significantly higher with ultrafiltration (p < 0.05) versus those observed for the other two methods. The plasma thromboplastin times were significantly (p < 0.05) longer after cardiopulmonary bypass with centrifugation as compared to direct infusion and ultrafiltration. However, the coagulation profiles and plasma composition normalized by 18 hours after cardiopulmonary bypass with all three blood-salvaging methods. There were no significant differences in terms of blood utilization or chest tube drainage over the entire postoperative period among any of the circuit blood-salvaging methods. These results suggest that ultrafiltration of postcardiopulmonary circuit blood may preserve plasma colloid pressure and platelet concentration in the early postoperative period, but these differences do not persist. Thus, for routine cardiopulmonary bypass procedures, direct infusion, centrifugation, and ultrafiltration may all be satisfactory methods of circuit blood salvage.
体外循环结束时体外循环血液的回输是心脏直视手术中血液保护的一个重要特征。然而，不同体外循环血液回收方法的相对优缺点仍不明确。因此，本研究的目的是检验三种不同的体外循环血液回收技术：直接输注、离心和超滤之间是否存在可量化的差异。60例术前特征非常相似的患者被随机分为三组，在体外循环后20分钟以及6小时和18小时测定凝血筛查、血浆指标和呼吸功能。体外循环后早期（20分钟），与其他两种方法相比，超滤组的血浆胶体渗透压、纤维蛋白原和血小板浓度显著更高（p<0.05）。与直接输注和超滤相比，离心法体外循环后血浆凝血活酶时间显著更长（p<0.05）。然而，采用所有三种血液回收方法，体外循环后18小时凝血指标和血浆成分均恢复正常。在整个术后期间，任何一种体外循环血液回收方法在血液利用或胸管引流量方面均无显著差异。这些结果表明，体外循环后血液超滤可能在术后早期维持血浆胶体渗透压和血小板浓度，但这些差异不会持续存在。因此，对于常规体外循环手术，直接输注、离心和超滤可能都是令人满意的体外循环血液回收方法。
