压力场作为心脏手术期间液体管理和红细胞保存的方法,Journal of Cardiothoracic Surgery

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压力场作为心脏手术期间液体管理和红细胞保存的方法
Journal of Cardiothoracic Surgery ( IF 1.5 ) Pub Date : 2023-01-18 , DOI: 10.1186/s13019-023-02134-3
Stephen F Woodford _{1,

2,

3,

4} , Mark Butlin ₄ , Bai Wei ₅ , Wei Chao ₆ , Alberto Avolio ₄

Affiliation

贫血和红细胞输注会增加手术的发病率和死亡率。患者血液管理以减轻术前贫血、优化凝血、术中保存红细胞和接受较低的术后输血阈值的概念最近在一系列外科学科中得到了广泛接受。输液可能会显着增加围手术期贫血和红细胞输血需求，但尚未阐明在这方面管理输液的坚实基础。迫切需要这样做。我们开发了“压力场方法”，作为一种指导液体和药物管理以优化组织灌注的新方法。采用压力场法对67例半择期心脏手术患者进行术中管理。我们将这个队列中的术中贫血和输血需求与 413 名接受心脏手术的传统患者组进行了比较。在压力场组中，没有患者需要输血，而在常规组中，16% 的患者在搭桥期间需要输血，这些患者平均接受 2.4 个单位的浓缩红细胞 (P < 0.0001)。压力场组的血红蛋白平均下降仅为 13 g/L，而常规组为 52 g/L (P < 0.0001)。80%的压力场组在心脏手术期间未接受静脉输液，术中平均液体负荷为115 mL。

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The pressure field as a methodology for fluid management and red cell preservation during cardiac surgery

Anemia and red cell transfusion contribute to morbidity and mortality of surgery. The concept of patient blood management to mitigate preoperative anemia, optimize coagulation, conserve red cells intraoperatively and accept lower post-operative transfusion thresholds has recently gained widespread acceptance across a range of surgical disciplines. Fluid administration is likely to contribute significantly to perioperative anemia and red-cell transfusion requirements, yet a robust basis for managing fluid administration in this context has not been articulated. There is an urgent need for this. We developed ‘the pressure field method’ as a novel approach to guiding the administration of fluid and drugs to optimize tissue perfusion. The pressure field method was used for the intraoperative management of 67 patients undergoing semi-elective cardiac surgery. We compared intraoperative anemia and transfusion requirements in this cohort with a conventional group of 413 patients undergoing cardiac surgery. In the pressure field group, no patients required transfusion whereas in the conventional group, 16% required transfusion during bypass and these patients received an average of 2.4 units of packed red cells (P < 0.0001). The average decrease in hemoglobin in the pressure field group was only 13 g/L, whereas in the conventional group it was 52 g/L (P < 0.0001). 80% of the pressure field group received no intravenous fluid during cardiac surgery, and the average intraoperative fluid load was 115 mL. The pressure field method appears to reduce transfusion requirements due to decreased intraoperative fluid loading.

更新日期：2023-01-19

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