[罂粟摘要]微创体外循环对冠状动脉搭桥术中围手术期静脉输液管理的影响

微创体外循环对冠状动脉搭桥术中围手术期静脉输液管理的影响

贵州医科大学  麻醉与心脏电生理课题

翻译:  邓举

编辑:  严旭

审校: 曹莹

目的：比较随机分为微创体外循环（MiECC）和常规体外循环（CECC）的患者进行冠状动脉搭桥择期手术时血液制品和静脉输液管理的使用情况。

方法：共有240例计划进行首次泵上CABG（冠状动脉搭桥手术）治疗的患者被随机分配到MiECC组或CECC组。研究时间为术后的前84小时。以血红蛋白<80 g/l作为输血触发点。

结果：MiECC组术中红细胞输注的频率较低（23.3% vs 9.2%，P = 0.005），MiECC组总静脉液摄入量明显较低（3300ml[2950-4000]vs4800ml[4000-5500]，P < 0.001）。MiECC组的血红蛋白下降率较低（35.5 ± 8.9 g/l vs 50.7 ± 9 g/l，P < 0.001），血红蛋白下降百分比也较低（25.3 ± 6% vs 35.3 ± 5.9%，P < 0.001）。MiECC组的胸管引流输出量较高（645ml[500-917.5]vs550ml[412.5-750]，P = 0.001)。特别是，高达600 ml类别的胸管引流，有利于CECC组（59.1% vs 40.8%，P = 0.003）。ROC曲线分析显示，到达重症监护病房时血红蛋白水平低于95 g/l的患者与术后发生房颤（POAF）的风险增加相关（p = 0.002，auc = 0.61，截止<95，敏感性= 0.47，阳性预测值= 0.64）。

结论：与CECC组相比，MiECC减少了术中输血和静脉输液的需要，也减少了血红蛋白下降。术后血红蛋白下降是POAF的一个预测因子。

原始文献来源  ：

Sten Ellam,Jenni Räsänen, Juha Hartikainen,et al.Impact of minimal invasive extracorporeal circulation on perioperative intravenous fluid management in coronary artery bypass surgery［J］.Perfusion 2023, 38(1) 135–141 .

英文原文：

Impact of minimal invasive extracorporeal circulation on perioperative intravenous fluid management in coronary artery bypass surgery

Abstract

Objective: Compare the use of blood products and intravenous fluid management in patients scheduled for coronary artery bypass surgery and randomized to minimal invasive extracorporeal circulation (MiECC) and conventional extracorporeal 

circulation (CECC). 

Methods: A total of 240 patients who were scheduled for their first on-pump CABG, were randomized to MiECC or CECC groups. The study period was the first 84 hours after surgery. Hemoglobin <80 g/l was used as transfusion trigger. 

Results: Red blood cell transfusions intraoperatively were given less often in the MiECC group (23.3% vs 9.2%, p = 0.005) and the total intravenous fluid intake was significantly lower in the MiECC group (3300 ml [2950–4000] vs 4800 ml [4000– 

5500], p < 0.001). Hemoglobin drop also was lower in the MiECC group (35.5 ± 8.9 g/l vs 50.7 ± 9 g/l, p < 0.001) as was hemoglobin drop percent (25.3 ± 6% vs 35.3 ± 5.9%, p < 0.001). Chest tube drainage output was higher in the MiECC group (645 ml [500–917.5] vs 550 ml [412.5–750], p = 0.001). Particularly, chest tube drainage in up to 600 ml category, was in benefit of CECC group (59.1% vs 40.8%, p = 0.003). ROC curve analysis showed that patients with hemoglobin level below 95 g/l upon arrival to intensive care unit was associated with increased risk of developing postoperative atrial fibrillation (POAF) (p = 0.002, auc = 0.61, cutoff <95, sensitivity = 0.47, positive predictive value = 0.64). 

Conclusion: MiECC reduced the intraoperative need for RBC transfusion and intravenous fluids compared to the CECC group, also reducing hemoglobin drop compared to the CECC group in CABG surgery patients. Postoperative hemoglobin drop was a predictor of POAF

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