同种异体血液制品在最小化体外循环系统(MECC)冠状动脉旁路移植术(CABG)中的应用与标准无泵冠状动脉旁路移植术的比较

The Open Cardiovascular Medicine Journal Pub Date : 2016-06-30 eCollection Date: 2016-01-01 DOI:10.2174/1874192401610010148
M Lisy, E Schmid, J Kozok, P Rosenberger, U A Stock, G Kalender
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引用次数: 3

摘要

目的:心脏手术术中输注同种异体血液制品(ABPT)与较差的总体预后(包括死亡率)相关。本研究的目的是评估最小化体外心肺(MECC(TM))与标准开放系统无泵冠状动脉血运重建术的ABPTs。方法:回顾性分析2008年9月至2010年9月156例心肌血运重建术患者的资料。83例采用MECC技术,73例采用标准体外循环(sECC)。分析ABPT及术后早期并发症。结果:两组手术死亡率和发病率相似。术中,MECC组ABPT均显著低于sECC组(7.2% vs. 60.3%)。结论:应用MECC进行无泵冠状动脉旁路移植术(CABG)可显著降低ABPT,缩短ICU和住院时间。为了实现MECC自体逆行启动的这些好处,双谱指数(BIS)监测、术中细胞回收、细致止血和严格的围术后体积管理至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Allogeneic Blood Product Usage in Coronary Artery Bypass Grafting (CABG) with minimalized Extracorporeal Circulation System (MECC) Versus Standard On-Pump Coronary Artery Bypass Grafting.

Allogeneic Blood Product Usage in Coronary Artery Bypass Grafting (CABG) with minimalized Extracorporeal Circulation System (MECC) Versus Standard On-Pump Coronary Artery Bypass Grafting.

Allogeneic Blood Product Usage in Coronary Artery Bypass Grafting (CABG) with minimalized Extracorporeal Circulation System (MECC) Versus Standard On-Pump Coronary Artery Bypass Grafting.

Allogeneic Blood Product Usage in Coronary Artery Bypass Grafting (CABG) with minimalized Extracorporeal Circulation System (MECC) Versus Standard On-Pump Coronary Artery Bypass Grafting.

Aim: Intraoperative allogeneic blood product transfusion (ABPT) in cardiac surgery is associated with worse overall outcome, including mortality. The objective of this study was to evaluate the ABPTs in minimalized extracorporeal cardiopulmonary (MECC(TM)) compared with standard open system on-pump coronary revascularization.

Methods: Data of 156 patients undergoing myocardial revascularization between September 2008 and September 2010 were reviewed. 83 patients were operated by the MECC technique and 73 were treated by standard extracorporeal circulation (sECC). ABPT and overall early postoperative complications were analyzed.

Results: Operative mortality and morbidity were similar in both groups. ABPT in the MECC group was significantly lower than in the sECC group both intraoperatively (7.2 vs. 60.3% of patients p<0.001) and during the first five postoperative days (19.3 vs. 57.5%; p<0.001). "Skin to skin"- (214 ± 45 vs. 232 ± 45 min; p=0.012), cardiopulmonary bypass (CPB) - (82 ± 25 vs. 95 ± 26 min; p=0.014), and X-clamp- times (50 ± 16 vs. 56 ± 17 min; p=0.024) were significantly lower in the MECC group than in the sECC group. Length of ICU (intensive care unit) - and hospital stay were also significantly lower in the MECC group vs. the sECC group (26.7 ± 20.2 vs. 54.5 ± 68.9 h; p<0.001, and 12.0 ± 4.1 vs. 14.5 ± 4.6 days; p<0.001).

Conclusion: Application of MECC as on-pump coronary artery bypass graft (CABG) results in significantly lower ABPT as well as shorter ICU and in-hospital stay. In order to achieve these benefits of MECC autologous retrograde priming, Bispectral index (BIS) monitoring, intraoperative cell salvage, meticulous hemostasis and strict peri- and postoperative volume management are crucial.

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