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在胸前动脉外科手术中,血栓形成导向输血管理的有效性

Yushi Okumura¹, Tomohiro Mizuno¹, Tatsuki Fujiwara¹

¹Department of Cardiovascular Surgery, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan.

Annals of thoracic surgery short reports

|January 10, 2025

概括

在手术内进行的血栓显微镜 (TEG) 引导的输血管理有效地减少了胸前大动脉手术患者的术后出血和输血量. 这种方法改善了结果,但没有影响早期或中期生存率.

科学领域:

心血管外科心血管外科
输血医学输血医学
凝血监测凝血监测凝血监测

背景情况:

胸前动脉手术经常需要大量的输血,因为手术前的凝血病和延长的心肺绕道 (CPB) 时间.
优化血液管理策略对于改善复杂心脏手术患者的治疗结果至关重要.

研究的目的:

评估在经过胸前动脉外科手术的患者中,手术内血栓导电图 (TEG) 引导的输血管理的疗效.
评估TEG引导输血对术后出血和血液制品利用的影响.

主要方法:

一项涉及53名接受选择性胸前大动脉手术的患者的比较研究,分为传统 (C组,n=25) 和TEG导向 (T组,n=28) 管理.
在T组 (CPB前和后) 中,TEG进行了两次. 红细胞 (RBC) 和新鲜冷血 (FFP) 的输血协议标准化,在T组基于TEG参数 (CFF-MA) 的特定比率和触发器.
关键指标包括术后出血,CPB后红细胞输血和术后红细胞/FFP输血.

主要成果:

与C组相比,T组的术后出血,CPB后红血球输血,术后红血球输血和术后FFP输血量显着较低 (P < .05对所有).
两组之间早期和中期存活率没有显著差异.

结论:

术内TEG引导的输血管理是减少手术后出血和胸前动脉手术中血液产品需求的有效策略.
以TEG为指导的管理为优化高风险心脏手术中的输血实践提供了宝贵的工具.

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