激活凝血时间值作为术后出血和输血的独立预测指标
Rafael Maniés Pereira1,2, Diogo Magueijo3, Nuno Carvalho Guerra1
1Department of Cardiothoracic Surgery, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal.
概括
最终激活凝血时间 (ACT) ≥140s预测心脏手术患者的术后出血和输血风险增加. 更长的心肺绕道术时间也增加了这些风险,性别影响了结果.
科学领域:
- 心血管外科心血管外科
- 麻醉学 麻醉学
- 血液学 血液学 血液学
背景情况:
- 激活凝血时间 (ACT) 监测对于心脏手术期间的抗凝血非常重要.
- 术后出血和输血的最终ACT的预测价值需要进一步评估.
研究的目的:
- 评估最终ACT在预测术后出血和输血需求方面的有用性.
- 确定理想的最终ACT值,以尽量减少不良结果.
主要方法:
- 722名心脏手术患者的回顾性分析 (2018年7月-2021年10月).
- 基于最终ACT水平 (<140s与≥140s) 的出血和输血率的比较.
- 使用威尔科克森等级和,奇方,费舍尔精确,线性混合回归和二进制后勤回归模型的统计分析.
主要成果:
- 最终ACT≥140s的患者在12h和24h显著增加了术后出血 (P<0.01).
- 心肺绕道 (CPB) 时间和男性性别是出血的独立预测因素.
- 较高的最终ACT (≥140s) 与输血风险增加相关 (OR 1.81).
- CPB时间和最后的ACT是输血的重要预测因素;女性预测输血的可能性更高,特别是在紧急手术中.
结论:
- 最终ACT证明了对输血使用的良好预测价值.
- 最终ACT≥140s与输血风险升高和出血增加有关.
- 延长CPB时间增加出血和输血风险.
- 男性面临更高的出血风险,而女性面临更高的输血风险.
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