Safety of deliberate intraoperative and postoperative hypothermia for patients undergoing coronary artery surgery: A randomized trial
Safety of deliberate intraoperative and postoperative hypothermia for patients undergoing coronary artery surgery: A randomized trial
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DOI：
10.1016/j.jtcvs.2003.07.018
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发表时间：
2004-05-01
影响因子：
6
通讯作者：
Wells, GA
中科院分区：
文献类型：
--
作者：
Nathan, HJ;Parlea, L;Wells, GA
背景：围手术期体温过低与不良反应有关，尤其是出血。在终止体外循环之前，通常会增加复温时间和灌流温度，以避免体外循环后体温过低和可能出现的并发症。然而，这种做法也可能有不利的影响，特别是脑温过高。我们介绍了一项试验的安全性结果，在该试验中，接受冠状动脉手术的患者在整个手术过程中被随机分配到常温或低温状态。方法：60岁以上的首次选择体外循环冠状动脉手术的患者被随机分配到在整个术中期间鼻咽温度保持在37℃(N组，73例)或34℃(H组，71例)，在到达重症监护病房之前没有复温。所有患者均接受氨甲环酸治疗。结果：术中血液产物或肌力调节剂的使用在临床上没有重要差异。到达重症监护病房时，N组和H组的温度分别为36.7℃+/-0.38℃和34.3℃+/-0.38℃。术后12小时内，N组出血量为596+/-356毫升，H组为666+/-405毫升(平均差值+/-95%可信区间70+/-126毫升；P=0.28)。在血液产品利用率、插管时间、住院时间、心肌梗死或死亡率方面没有显著差异。在重症监护病房，低温组平均住院时间减少了8.4小时(P=0.02)。结论：我们的数据支持围术期亚低温在体外循环下非再手术冠状动脉手术患者中的安全性。这些发现表明低温体外循环后完全复温并不是所有病例都有必要的。
Background: Hypothermia in the perioperative period is associated with adverse effects, particularly bleeding. Before termination of cardiopulmonary bypass, rewarming times and perfusion temperatures are often increased to avoid post-cardiopulmonary bypass hypothermia and the presumed complications. This practice may, however, also have adverse effects, particularly cerebral hyperthermia. We present safety outcomes from a trial in which patients undergoing coronary artery surgery were randomly assigned to normothermia or hypothermia for the entire surgical procedure.Methods: Consenting patients over the age of 60 years presenting for a first, elective coronary artery surgery with cardiopulmonary bypass were randomly assigned to having their nasopharyngeal temperature maintained at either 37degreesC (group N; 73 patients) or 34degreesC (group H; 71 patients) throughout the intraoperative period, with no rewarming before arrival in the intensive care unit. All received tranexamic acid.Results: There was no clinically important difference in intraoperative blood product or inotrope use. Temperatures on arrival in the intensive care unit were 36.7degreesC +/- 0.38degreesC and 34.3degreesC +/- 0.38degreesC in groups N and H, respectively. Blood loss during the first 12 postoperative hours was 596 +/- 356 mL in group N and 666 +/- 405 mL in group H (mean difference +/- 95% confidence interval, 70 +/- 126 mL; P = .28). There was no significant difference in blood product utilization, intubation time, time in the hospital, myocardial infarction, or mortality. The mean time in the intensive care unit was 8.4 hours less in the hypothermic group (P = .02).Conclusions: Our data support the safety of perioperative mild hypothermia in patients undergoing elective nonreoperative coronary artery surgery with cardiopulmonary bypass. These findings suggest that complete rewarming after hypothermic cardiopulmonary bypass is not necessary in all cases.