低血红蛋白输注高血红蛋白输注对择期血管手术患者心输出量的影响

低血红蛋白输注与高血红蛋白输注对择期血管手术患者心输出量的影响:一项随机试验研究

贵州医科大学  麻醉与心脏电生理课题组

翻译：马艳燕   编辑：张中伟   审校：曹莹

  01   背景

在血管手术中，通过近红外光谱分析，限制性红细胞输注可以降低额叶氧饱和度(ScO2)。我们评估了血液稀释后心输出量(CO)无明显增加是否可以解释ScO2的降低。

  02   方法

随机抽取46例患者手术结束前的数据进行事后分析，将所有患者随机分为血红蛋白＜8.0g/dL（低触发）、＜9.7g/dL（高触发）两组。通过优化每搏输出量来指导输液，比较术中CO、血红蛋白、供氧量、最低SCO2时的平均CO水平，并根据年龄、手术类型和基线进行线性回归校正。

  03   结果

与高触发组相比，低触发组的术中平均血红蛋白水平(平均差,−0.74 g/dL,P<0.001)和红细胞输入量(中位数[四分位数范围]，0 [0-300]vs 450 mL [300-675],P<0.001)降低了7.1%；与高触发组相比，低触发组的术中平均CO数值高7.3%(平均差0.36 L/min;95%CI，−0.05至0.78;P = 0.092;n = 42)。在最低的SCO2水平，低触发组CO升高11.9%(平均差0.58 L/ min;95%CI, 0.10 -1.07;P =0 .024)。试验组之间供氧量差异无统计学意义(MD,1.39 dLO2 /min;95%CI，−6.16 ~ 8.93;P=0.721)。

    0 4 结论

血管外科手术患者限制性红细胞输注会引起预期的CO增加，但潜在的有限的心脏容量不能解释相关的SCO2下降。

  0 5 原始文献来源

Møller A, Wetterslev J, Shahidi S, et al. Effect of low vs high haemoglobin transfusion trigger on cardiac output in patients undergoing elective vascular surgery: Post-hoc analysis of a randomized trial[J]. Acta Anaesthesiol Scand. 2021;65(3):302-312.

英文原文    

Effect of low vs high haemoglobin transfusion trigger on cardiac output in patients undergoing elective vascular surgery: Post-hoc analysis of a randomized trial

Abstract

Background: During vascular surgery, restricted red-cell transfusion reduces frontal lobe oxygen (ScO2) saturation as determined by near-infrared spectroscopy. We evaluated whether inadequate increase in cardiac output (CO) following haemodilution explains reduction in ScO2.

Methods: This is a post-hoc analysis of data from the Transfusion in Vascular surgery (TV) Trial where patients were randomized on haemoglobin drop below 9.7 g/dL to red-cell transfusion at haemoglobin below 8.0 (low-trigger) vs 9.7 g/dL (high-trigger). Fluid administration was guided by optimizing stroke volume. We compared mean intraoperative levels of CO, haemoglobin, oxygen delivery, and CO at nadir ScO2 with linear regression adjusted for age, operation type and baseline. Data for 46 patients randomized before end of surgery were included for analysis.

Results: The low-trigger resulted in a 7.1% lower mean intraoperative haemoglobin level (mean difference, −0.74 g/dL; P < .001) and reduced volume of red-cell transfused (median [inter-quartile range], 0 [0-300] vs 450 mL [300-675]; P < .001) compared with the high-trigger group. Mean CO during surgery was numerically 7.3% higher in the low-trigger compared with the high-trigger group (mean difference, 0.36 L/min; 95% confidence interval (CI.95), −0.05 to 0.78; P = .092; n = 42). At the nadir ScO2-level, CO was 11.9% higher in the low-trigger group (mean difference, 0.58 L/ min; CI.95, 0.10-1.07; P = .024). No difference in oxygen delivery was detected between trial groups (MD, 1.39 dLO2/min; CI.95, −6.16 to 8.93; P = .721).

Conclusion: Vascular surgical patients exposed to restrictive RBC transfusion elicit the expected increase in CO making it unlikely that their potentially limited cardiac capacity explains the associated ScO2 decrease.

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