小容量血液稀釋對心臟手術(shù)患者圍術(shù)期臨床結(jié)局影響的研究
發(fā)布時間：2019-02-27 19:45
【摘要】：目的:回顧性評價術(shù)中使用小容量急性等容性血液稀釋(acute normovolemic hemodilution,ANH)對行體外循環(huán)(cardiopulmonary bypass,CPB)心臟手術(shù)患者術(shù)中紅細胞等血制品使用情況以及住院期間死亡率、機械通氣時間、ICU住院時間、術(shù)后住院時間和其它臨床結(jié)局情況的各種影響。方法:通過查閱浙江大學(xué)醫(yī)學(xué)院附屬第二醫(yī)院電子病例,回顧性研究自2010年1月～2015年5月2058例體外循環(huán)下的心臟手術(shù)患者。依照術(shù)前是否使用ANH分2組:ANH組和非ANH組。我們分析小容量ANH和圍術(shù)期結(jié)局的相關(guān)性。數(shù)據(jù)庫收集的數(shù)據(jù)其中包括了術(shù)前的一般資料、術(shù)中各項指標(biāo)和術(shù)后的觀察指標(biāo)。術(shù)前的一般資料包括患者年齡、身高、性別、體重、既往用藥情況、既往病史。術(shù)中相關(guān)指標(biāo)包括手術(shù)時間、體外循環(huán)時間、主動脈阻斷時間、手術(shù)類型和手術(shù)方式。主要觀察指標(biāo)為術(shù)中紅細胞輸注率;次要觀察指標(biāo)包括其它圍術(shù)期血制品輸注率和量,術(shù)后肺部感染率,住院期間死亡率,腦卒中,新發(fā)房顫,因大出血再次手術(shù),急性腎功能衰竭,機械通氣時間,ICU住院天數(shù),術(shù)后住院天數(shù)和其它臨床結(jié)局。結(jié)果:傾向性匹配前一共有1289名患者納入本研究,其中有358例患者在術(shù)前接受ANH,931例患者術(shù)前未行ANH。在1289名患者中,其中有38.8%(500例)患者在圍術(shù)期進行紅細胞輸注,10%(129例)患者進行血小板輸注,56.4%(727例)進行新鮮冰凍血漿輸注。按1:1傾向值匹配后總共708例配對成功,每組均有354例患者,匹配后兩組患者的術(shù)前一般情況資料與術(shù)中情況差異均無統(tǒng)計學(xué)意義。進行傾向性匹配后,與非ANH組相比,ANH組術(shù)中紅細胞輸注率(8.5%vs.14.4%;P=0.013),紅細胞輸注量(164 ml vs.289 ml;P=0.019),以及術(shù)后肺部感染發(fā)生率(6.8 vs.11.3%;P=0.036)均明顯降低。但兩組間的冰凍血漿輸注率、血小板輸注率以及術(shù)后異體血輸注率差異并沒有統(tǒng)計學(xué)意義。兩組間包括死亡率、切口愈合延長發(fā)生率、腦梗塞發(fā)病率、新發(fā)房顫發(fā)生率、因大出血而再次手術(shù)率、急性腎功能損傷發(fā)生率、術(shù)后機械通氣時間、ICU停留時間差異均無統(tǒng)計學(xué)意義。結(jié)論:在本回顧性研究中,體外循環(huán)下的心臟手術(shù)前采用小容量急性等容性血液稀釋,能有效降低心臟手術(shù)病人在術(shù)中的紅細胞輸注率和術(shù)后肺部感染發(fā)生率。但對術(shù)后及術(shù)中異體輸血情況、急性腎功能損傷發(fā)生率及住院時間、術(shù)后死亡率、ICU停留時間無明顯影響。
[Abstract]:Objective: to retrospectively evaluate the use of small volume acute normovolemic hemodilution (acute normovolemic hemodilution,ANH) during heart surgery with cardiopulmonary bypass (cardiopulmonary bypass,CPB) in patients with erythrocytes and other blood products and the mortality rate during hospitalization. Effects of mechanical ventilation duration, length of stay in ICU, postoperative hospitalization time and other clinical outcomes. Methods: 2058 patients undergoing cardiac surgery under cardiopulmonary bypass (CPB) from January 2010 to May 2015 were retrospectively studied by referring to the electronic cases in the second affiliated Hospital of Zhejiang University Medical College. According to whether to use ANH before operation, they were divided into two groups: ANH group and non-ANH group. We analyzed the correlation between small volume ANH and perioperative outcome. The data collected in the database included pre-operative general data, intraoperative and postoperative observations. Pre-operative data include age, height, sex, weight, past medication, and previous medical history. The operative parameters included operation time, cardiopulmonary bypass time, aortic cross-clamping time, operation type and operation mode. The main outcome measures were intraoperative red blood cell infusion rate; Secondary outcome measures included other perioperative blood transfusion rates and quantities, postoperative pulmonary infection rate, mortality during hospitalization, stroke, new atrial fibrillation, reoperation due to massive hemorrhage, acute renal failure, duration of mechanical ventilation, days of hospitalization of ICU. Postoperative hospital stay and other clinical outcomes. Results: a total of 1289 patients were enrolled in the study before predisposition matching. Among them, 358 patients received ANH,931 before operation and no ANH. was performed before operation. Of the 1289 patients, 38.8% (500 cases) received peri-operative red blood cell infusion, 10% (129 cases) received platelet transfusion, and 56.4% (727 cases) received fresh frozen plasma infusion. A total of 708 matched patients were successfully matched according to the 1:1 tendency value, and 354 patients in each group. There was no significant difference between the preoperative and intraoperative data of the two groups after the match. Compared with the non-ANH group, the intraoperative erythrocyte infusion rate (8.5% vs. 14.4%) and erythrocyte transfusion volume (164 ml vs.289 ml;) in the ANH group were compared with those in the non-ANH group. P0. 019) and postoperative pulmonary infection rate (6. 8 vs.11.3%;P=0.036) were significantly lower than those of control group (P < 0. 019). However, there was no significant difference in frozen plasma infusion rate, platelet transfusion rate and allogeneic blood transfusion rate between the two groups. The two groups included mortality rate, rate of wound healing prolongation, incidence of cerebral infarction, incidence of new atrial fibrillation, re-operation rate due to massive hemorrhage, incidence of acute renal function injury, time of postoperative mechanical ventilation, There was no significant difference in the stay time of ICU. Conclusion: in this retrospective study, small volume acute normovolemic hemodilution before cardiac surgery under cardiopulmonary bypass can effectively reduce the rate of red blood cell transfusion and the incidence of postoperative pulmonary infection in patients undergoing cardiac surgery. However, there was no significant effect on the postoperative and intraoperative allogeneic blood transfusion, the incidence of acute renal function injury, the length of hospitalization, the postoperative mortality and the stay time of ICU.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R614
，
本文編號：2431523
[Abstract]:Objective: to retrospectively evaluate the use of small volume acute normovolemic hemodilution (acute normovolemic hemodilution,ANH) during heart surgery with cardiopulmonary bypass (cardiopulmonary bypass,CPB) in patients with erythrocytes and other blood products and the mortality rate during hospitalization. Effects of mechanical ventilation duration, length of stay in ICU, postoperative hospitalization time and other clinical outcomes. Methods: 2058 patients undergoing cardiac surgery under cardiopulmonary bypass (CPB) from January 2010 to May 2015 were retrospectively studied by referring to the electronic cases in the second affiliated Hospital of Zhejiang University Medical College. According to whether to use ANH before operation, they were divided into two groups: ANH group and non-ANH group. We analyzed the correlation between small volume ANH and perioperative outcome. The data collected in the database included pre-operative general data, intraoperative and postoperative observations. Pre-operative data include age, height, sex, weight, past medication, and previous medical history. The operative parameters included operation time, cardiopulmonary bypass time, aortic cross-clamping time, operation type and operation mode. The main outcome measures were intraoperative red blood cell infusion rate; Secondary outcome measures included other perioperative blood transfusion rates and quantities, postoperative pulmonary infection rate, mortality during hospitalization, stroke, new atrial fibrillation, reoperation due to massive hemorrhage, acute renal failure, duration of mechanical ventilation, days of hospitalization of ICU. Postoperative hospital stay and other clinical outcomes. Results: a total of 1289 patients were enrolled in the study before predisposition matching. Among them, 358 patients received ANH,931 before operation and no ANH. was performed before operation. Of the 1289 patients, 38.8% (500 cases) received peri-operative red blood cell infusion, 10% (129 cases) received platelet transfusion, and 56.4% (727 cases) received fresh frozen plasma infusion. A total of 708 matched patients were successfully matched according to the 1:1 tendency value, and 354 patients in each group. There was no significant difference between the preoperative and intraoperative data of the two groups after the match. Compared with the non-ANH group, the intraoperative erythrocyte infusion rate (8.5% vs. 14.4%) and erythrocyte transfusion volume (164 ml vs.289 ml;) in the ANH group were compared with those in the non-ANH group. P0. 019) and postoperative pulmonary infection rate (6. 8 vs.11.3%;P=0.036) were significantly lower than those of control group (P < 0. 019). However, there was no significant difference in frozen plasma infusion rate, platelet transfusion rate and allogeneic blood transfusion rate between the two groups. The two groups included mortality rate, rate of wound healing prolongation, incidence of cerebral infarction, incidence of new atrial fibrillation, re-operation rate due to massive hemorrhage, incidence of acute renal function injury, time of postoperative mechanical ventilation, There was no significant difference in the stay time of ICU. Conclusion: in this retrospective study, small volume acute normovolemic hemodilution before cardiac surgery under cardiopulmonary bypass can effectively reduce the rate of red blood cell transfusion and the incidence of postoperative pulmonary infection in patients undergoing cardiac surgery. However, there was no significant effect on the postoperative and intraoperative allogeneic blood transfusion, the incidence of acute renal function injury, the length of hospitalization, the postoperative mortality and the stay time of ICU.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R614
，
本文編號：2431523
本文鏈接：http://sikaile.net/yixuelunwen/waikelunwen/2431523.html
最近更新
教材專著
