Jansen P G, Baufreton C, Le Besnerais P, Loisance D Y, Wildevuur C R
Service de Chirurgie Thoracique et Cardiovasculaire, Centre Nacional de la Recherche Scientifique Unité de Recherche Associeé 1431, Hôpital Henri Mondor, Créteil, France.
Ann Thorac Surg. 1996 May;61(5):1363-6. doi: 10.1016/0003-4975(96)00056-2.
The biocompatibility of an extracorporeal circuit is improved by heparin bonding onto its inner surface. To determine the effect of heparin-coated circuits for cardiopulmonary bypass with aprotinin prime on postoperative recovery and resource utilization, a prospective study was done in 102 patients undergoing coronary artery bypass grafting with full systemic heparinization.
Patients were randomly allocated to be treated with either a heparin-coated circuit (n = 51) or an uncoated circuit (n = 51). Differences in blood loss, need for blood transfusion, morbidity, and intensive care stay were analyzed.
No differences in blood loss and need for blood transfusion were found between the groups. The relative risk for adverse events in the heparin-coated group was 0.29 (95% confidence interval ranging from 0.10 to 0.80). Adverse events included myocardial infarction (2 patients in the uncoated group versus 0 in the heparin-coated group), rethoracotomy for excessive bleeding (1 versus 2), rhythm disturbance (7 versus 2), respiratory insufficiency (4 versus 0), and neurologic dysfunction (2 versus 0). The lower incidence of adverse events in the heparin-coated group was associated with a shorter intensive care stay (median, 2 days; range, 2 to 5 days) compared with the uncoated group (median, 3 days; range, 2 to 19 days, p = 0.03). The cost savings of 1 day of intensive care stay counterbalanced the additional costs of heparin-coated circuits.
The use of heparin-coated circuits for cardiopulmonary bypass with aprotinin prime resulted in a significant reduction in mobidity in the early postoperative phase and a concomitant decrease in intensive care stay, resulting in important cost savings.
通过将肝素结合到体外循环回路的内表面来改善其生物相容性。为了确定使用抑肽酶预充的肝素涂层回路进行体外循环对术后恢复和资源利用的影响，对102例接受冠状动脉旁路移植术并全身充分肝素化的患者进行了一项前瞻性研究。
将患者随机分配接受肝素涂层回路治疗（n = 51）或未涂层回路治疗（n = 51）。分析两组在失血量、输血需求、发病率和重症监护停留时间方面的差异。
两组之间在失血量和输血需求方面未发现差异。肝素涂层组不良事件的相对风险为0.29（95%置信区间为0.10至0.80）。不良事件包括心肌梗死（未涂层组2例，肝素涂层组0例）、因出血过多再次开胸手术（1例对2例）、心律失常（7例对2例）、呼吸功能不全（4例对0例）和神经功能障碍（2例对0例）。与未涂层组（中位数为3天；范围为2至19天，p = 0.03）相比，肝素涂层组较低的不良事件发生率与较短的重症监护停留时间相关（中位数为2天；范围为2至5天）。1天重症监护停留时间的成本节省抵消了肝素涂层回路的额外成本。
使用抑肽酶预充的肝素涂层回路进行体外循环可显著降低术后早期的发病率，并同时减少重症监护停留时间，从而节省重要成本。
