超滤对心脏手术心肺旁路期间全血凝血功能的影响:回顾性分析

IF 4.2 4区 医学 Q1 ANESTHESIOLOGY Korean Journal of Anesthesiology Pub Date : 2024-04-01 Epub Date: 2024-01-30 DOI:10.4097/kja.23698
Jaemoon Lee, Dong-Kyu Lee, Won-Kyoung Kwon, Sookyung Lee, Chung-Sik Oh, Klaus Görlinger, Tae-Yop Kim
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引用次数: 0

摘要

背景:超滤(UF)可在心脏手术心肺旁路(CPB)期间浓缩凝血因子,从而改善凝血状况:我们回顾性审查了一家大学医院 75 名接受心脏手术的患者的电子病历,这些患者接受了基于旋转血栓弹性测定的凝血管理,并分析了 30 名患者在 CPB 期间超滤引起的组织因子外激活试验(EXTEM)最大凝块坚固度(MCF)的变化:结果:无滤过水的中位体积为 1350 毫升,中位血细胞比容从 22.5% 显著升至 25.5%。作为主要测量指标,UF 使中位 MCF-EXTEM 从 48.0 mm 显著增加到 50.5 mm(P = 0.015,效应大小 r = 0.44)。应用 UF 前 MCF-EXTEM 的接收器操作特征曲线下面积为 0.89(95% CI:0.77-1.00,P <0.001),用于判别应用 UF 后 MCF-EXTEM 的任何增加,其临界值为 50.5 mm(Youden's J 统计的特异性为 81.8%,灵敏度为 84.2%)。在使用临界值进行的二次分析中,在18例UF前MCF-EXTEM≤50.5毫米的患者中,UF可使中位MCF-EXTEM从40.5毫米显著增加到42.5毫米。然而,在 12 例超导前 MCF-EXTEM > 50.5 mm 的患者中,MCF-EXTEM 没有增加。UF前的MCF-EXTEM值与应用UF之间存在明显的交互作用(亚组的P < 0.001,UF的P = 0.046,交互作用的P = 0.003):结论:应用 UF 可改善血凝块的坚固性,当 CPB 期间降低 UF 前 MCF-EXTEM 值时,改善效果更明显。
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Effect of ultrafiltration on whole blood coagulation profile during cardiopulmonary bypass in cardiac surgery: a retrospective analysis.

Background: Ultrafiltration (UF) would enhance coagulation profiles by concentrating coagulation elements during cardiopulmonary bypass (CPB) for cardiac surgery.

Methods: We retrospectively reviewed electronic medical records of 75 patients who had undergone cardiac surgery with rotational thromboelastometry-based coagulation management in a university hospital and analyzed the UF-induced changes in the maximum clot firmness (MCF) of extrinsically activated test with tissue factor (EXTEM) during CPB in 30 patients.

Results: The median volume of filtered-free water was 1,350 ml, and median hematocrit was significantly increased from 22.5% to 25.5%. As the primary measure, UF significantly increased the median MCF-EXTEM from 48.0 mm to 50.5 mm (P = 0.015, effect size r = 0.44). The area under the receiver operating characteristic curve pre-UF MCF-EXTEM for discrimination of any increase of MCF-EXTEM after applying UF was 0.89 (95% CI [0.77, 1.00], P < 0.001), and its cut-off value was 50.5 mm (specificity of 81.8% and sensitivity of 84.2% in Youden's J statistic). In the secondary analyses using the cut-off value, UF significantly increased the median MCF-EXTEM from 40.5 mm to 42.5 mm in 18 patients with pre-UF MCF-EXTEM ≤ 50.5 mm. However, it did not increase MCF-EXTEM in 12 patients with pre-UF MCF-EXTEM > 50.5 mm. There was a significant interaction between pre-UF MCF-EXTEM values and applying UF (P < 0.001 for the subgroup, P = 0.046 for UF, P = 0.003 for interaction).

Conclusions: Applying UF improved clot firmness, and the improvement was more pronounced when pre-UF MCF-EXTEM had been reduced during CPB.

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CiteScore
6.20
自引率
6.90%
发文量
84
审稿时长
16 weeks
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