体外循环心脏手术剩余机血超滤处理的前瞻性队列研究

Hemoconcentration and retransfusion of residual cardiopulmonary bypass pump blood: a prospective cohort study

目的研究体外循环下心脏手术剩余机血经超滤处理,是否可提高机血回输后对患者血红蛋白和血浆游离血红蛋白(PFHb)的增长量、减少机血回输量和术后肾功能的影响。方法入选60名择期行体外循环心脏手术的成人患者,对照组(n=30)将剩余机血直接经主动脉插管回输或收集至输血袋中经外周静脉回输;超滤组(n=30)则对机血进行超滤浓缩处理后回输。比较两组机血回输后患者血红蛋白及游离血红蛋白增长量(△Hb,△PFHb)、机血回输量、术后24 h引流量、术后机械通气时间、术后肌酐增长率及急性肾功能损伤(AKI)发生率。结果超滤组机血输注完毕后△Hb高于对照组[△Hb(18±11) g/L vs (12±6) g/L,P=0.03],机血回输量少于对照组[550(325,615) ml vs 1 000(900,1 180) ml,P <0.001],回输后患者△PFHb高于对照组[100(0,200) mg/L vs 0(-100,0) mg/L,P=0.03],术后24 h引流量、机械通气时间、术后血肌酐增长率及AKI发生率无统计学差异。结论与机血直接回输相比,体外循环下心脏手术剩余机血经超滤处理后回输可有效提高患者Hb水平、减轻液体负荷,虽然机血超滤可引起PFHb升高,但未发现与术后肾损伤相关。

Objective The aim of the study was to investigate whether residual pump blood hemoconcentration could increase the increment of hemoglobin after residual pump blood retransfusion and reduce retransfusion volume and to evaluate its influence on plasma free hemoglobin（ PFHb） level and postoperative kidney function. Methods Sixty adult patients undergoing elective cardiac surgery with cardiopulmonary bypass were assigned to two groups based on pump blood processing strategy： hemoconcentrated（ n = 30）or unprocessed（ control; n = 30）. Retransfusion volume,increment in hemoglobin and PFHb after retransfusion（ △Hb,△PFHb）,postoperative chest drainage volume（ first 24 h）,duration of mechanical ventilation,changes of serum creatinine and prevalence of AKI were compared between the two groups. Results The retransfusion volume was lower in hemoconcentration group（ 550（ 325,615） ml vs 1000（ 900,1180） ml,P〈0.001）. Higher levels of both △Hb and △FHb were observed after retransfusion in hemoconcentration group（ △Hb 1.8±1.1 g/dl vs 1.2±0.6 g/dl,P = 0.03,△PFHb 100（ 0,200） mg/L vs 0（-100,0） mg/L,P = 0.03）. No difference was found in postoperative chest drainage volume（ first 24 h）,duration of mechanical ventilation,change of serum creatinine and prevalence of AKI. Conclusion Compared with unprocessed group,hemoconcentration and retransfusion of residual CPB pump blood improved hemoglobin level and reduced fluid loading. Despite an increase in PFHb,the processing procedure was not related to postoperative kidney injury.