在成人心脏手术中急性血稀释
Kenichi A Tanaka1, Kenneth E Stewart1,2, Kofi B Vandyck1
1Department of Anesthesiology, University of Oklahoma Health Sciences Center, Oklahoma City.
JAMA surgery
|September 3, 2025
概括
在心脏手术患者中,急性正常血稀释 (ANH) 减少了输血. 这种安全且具有成本效益的血液保存技术在减少红细胞和非红细胞组件的有效性方面仍未得到充分利用.
科学领域:
- 心血管外科
- 麻醉学
- 输血医学
背景情况:
- 急性常态血稀释 (ANH) 是一种已知保存血液的方法.
- 美国的采用率很低,
- 血液供应减少需要重新评估ANH的有效性.
研究的目的:
- 评估ANH对外科手术前输血和血液成分使用的影响.
- 在心脏手术期间接受心肺旁路术 (CPB) 的患者中评估ANH.
主要方法:
- 使用STS成人心脏手术数据库 (v4. 20. 2) 进行了回顾性倾向评分对应的队列研究.
- 包括接受CABG和/或CPB门手术的成年患者 (2020年7月至2023年9月).
- 主要暴露:ANH; 主要结局:手术内/手术后输血; 二次结局:组件使用,重新探索,ICU停留,费用.
主要成果:
- 在16,795名患者中,ANH被用于14. 7%,与较低的手术前贫血和较高的血红素水平有关.
- 在匹配后,ANH使用的输血率显著降低 (31.2%与36.4%,P<.001).
- 大量的ANH (≥650毫升) 降低了47- 64%,降低了红细胞和非红细胞组件的使用和相关成本.
结论:
- 在心脏手术中,ANH与输血率降低之间存在体积依赖的关联.
- 这种药物是安全的,具有成本效益,并且可以明显减少血液成分的使用.
- 尽管有证据,但ANH在心脏外科手术中仍未得到充分利用.
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