体外循环的逆行自体预充：一种减少血液稀释和输血需求的安全有效方法。

Retrograde autologous priming for cardiopulmonary bypass: a safe and effective means of decreasing hemodilution and transfusion requirements.

作者信息

Rosengart T K, DeBois W, O'Hara M, Helm R, Gomez M, Lang S J, Altorki N, Ko W, Hartman G S, Isom O W, Krieger K H

机构信息

The New York Hospital-Cornell Medical Center, Department of Cardiothoracic Surgery, NY 10021, USA.

出版信息

J Thorac Cardiovasc Surg. 1998 Feb;115(2):426-38; discussion 438-9. doi: 10.1016/S0022-5223(98)70287-9.

DOI:10.1016/S0022-5223(98)70287-9

PMID:9475538

Abstract

OBJECTIVES

The obligatory hemodilution resulting from crystalloid priming of the cardiopulmonary bypass circuit represents a major risk factor for blood transfusion in cardiac operations. We therefore examined whether retrograde autologous priming of the bypass circuit would result in decreased hemodilution and red cell transfusion.

METHODS

Sixty patients having first-time coronary bypass were prospectively randomized to cardiopulmonary bypass with or without retrograde autologous priming. Retrograde autologous priming was performed at the start of bypass by draining crystalloid prime from the arterial and venous lines into a recirculation bag (mean volume withdrawal: 880 +/- 150 ml). Perfusion and anesthetic techniques were otherwise identical for the two groups. The hematocrit value was maintained at a minimum of 16% and 23% during and after cardiopulmonary bypass, respectively, in all patients. Patients were well matched for all preoperative variables, including established transfusion risk factors. Subsequent hemodynamic parameters, pressor requirements, and fluid requirements were equivalent in the two groups.

RESULTS

The lowest hematocrit value during cardiopulmonary bypass was 22% +/- 3% versus 20% +/- 3% in patients subjected to retrograde autologous priming and in control patients, respectively (p = 0.002). One (3%) of 30 patients subjected to retrograde autologous priming had intraoperative transfusion, and seven (23%) of 30 control patients required transfusion during the operation (p = 0.03). The number of patients receiving any homologous red cell transfusions in the two groups during the entire hospitalization was eight of 30 (27%; retrograde autologous priming) versus 16 of 30 (53%; control) (p = 0.03).

CONCLUSIONS

These data suggest that retrograde autologous priming is a safe and effective means of significantly decreasing hemodilution and the number of patients requiring red cell transfusion during cardiac operations.

摘要

目的

体外循环回路晶体预充导致的强制性血液稀释是心脏手术输血的主要危险因素。因此，我们研究了体外循环回路逆行自体预充是否会减少血液稀释和红细胞输注。

方法

60例首次行冠状动脉搭桥术的患者被前瞻性随机分为接受或不接受体外循环逆行自体预充的两组。在体外循环开始时，通过将晶体预充液从动脉和静脉管路引流至再循环袋（平均引流量：880±150ml）进行逆行自体预充。两组的灌注和麻醉技术相同。所有患者在体外循环期间和之后，血细胞比容值分别维持在至少16%和23%。两组患者的所有术前变量匹配良好，包括既定的输血危险因素。两组随后的血流动力学参数、升压药需求和液体需求相当。

结果

体外循环期间血细胞比容的最低值，逆行自体预充组患者为22%±3%，对照组患者为20%±3%（p=0.002）。30例行逆行自体预充的患者中有1例（3%）术中输血，30例对照组患者中有7例（23%）在手术期间需要输血（p=0.03）。在整个住院期间，两组中接受任何同源红细胞输注的患者数量，逆行自体预充组为30例中的8例（27%），对照组为30例中的16例（53%）（p=0.03）。