Armellin G, Sorbara C, Bonato R, Pittarello D, Dal Cero P, Giron G
Department of Anesthesiology and Critical Care, University of Padova, Italy.
J Cardiothorac Vasc Anesth. 1997 Feb;11(1):13-7. doi: 10.1016/s1053-0770(97)90245-7.
To determine the effects of intraoperative plasmapheresis on total transfusion requirements, mediastinal drainage, and coagulation.
The trial was prospective, randomized, and controlled.
Inpatient cardiac surgery at a university medical center.
Two hundred ninety-three consecutive patients undergoing cardiac surgery requiring cardiopulmonary bypass.
Intraoperative plasmapheresis (IP) was performed in 147 patients before heparinization; platelet-rich plasma was reinfused immediately after heparin reversal.
Mediastinal chest tube drainage during the first 12 postoperative hours was significantly less in the IP group (p = 0.022), but no difference was noted in total postoperative blood loss between the two groups. The amount of packed red cells and fresh frozen plasma transfused to the IP group in the intensive care unit was significantly lower (p = 0.02, p = 0.002, respectively); 51.4% of patients required no transfusion compared with the control group (34.5%) (p = 0.006). No differences were noted for data collected in the intensive care unit in terms of the mean duration of chest tube drainage, ventilator time, or any hematologic variables at baseline or at any subsequent time in the study.
After cardiac surgery, intraoperative plasma-pheresis reduces early postoperative bleeding and decreases the need for homologous transfusions.
确定术中血浆置换对总输血需求、纵隔引流和凝血的影响。
该试验为前瞻性、随机对照试验。
一所大学医学中心的住院心脏外科手术。
293例连续接受需要体外循环的心脏手术患者。
147例患者在肝素化前进行术中血浆置换（IP）；肝素逆转后立即回输富含血小板的血浆。
术后12小时内，IP组纵隔胸管引流量显著减少（p = 0.022），但两组术后总失血量无差异。重症监护病房中，IP组输注的红细胞悬液和新鲜冰冻血浆量显著较低（分别为p = 0.02，p = 0.002）；51.4%的患者无需输血，而对照组为34.5%（p = 0.006）。在重症监护病房收集的数据中，两组在胸管引流平均持续时间、呼吸机使用时间或研究基线及任何后续时间的任何血液学变量方面均无差异。
心脏手术后，术中血浆置换可减少术后早期出血并降低同种异体输血需求。
