Blood volume measurement by hemodilution: association with valve disease and re-evaluation of the Allen Formula
Blood volume measurement by hemodilution: association with valve disease and re-evaluation of the Allen Formula
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血液稀释法测量血容量：与瓣膜疾病的关联以及艾伦公式的重新评估
DOI：
10.1177/0267659114547250
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Jochen D. Muehlschlegel
中科院分区：
文献类型：
--
作者：
J. Hilberath;Megha Elizabeth Thomas;T. Smith;C. Jara;Daniel J. Fitzgerald;Kerry Wilusz;X. Liu;Jochen D. Muehlschlegel
背景：总血容量（TBV）评估是心脏外科手术合并体外循环（CPB）患者管理的核心。广泛接受的Allen公式在估计这些患者的TBV时缺乏准确性。此外，常见的心脏疾病状态对TBV的影响还没有系统的研究。本研究的目的是通过血液稀释来确定瓣膜疾病患者的TBV (TBVHD)，将TBVHD与心脏手术中常用的算法进行比较，并修改Allen公式以更好地适应当今的患者群体。方法：在CPB启动时前瞻性测定TBVHD。96例患者根据术前诊断分为4组，并在单因素分析中与Allen和体重公式进行比较：二尖瓣反流（MR）、冠状动脉疾病需要搭桥手术（CABG）和主动脉狭窄（AS）±CABG。身高和体重对TBV的独立影响通过多元线性回归与原Allen公式相关。结果：MR患者的TBVHD明显大于AS、CABG或两者兼而有之的患者。AS和冠脉搭桥患者TBVHD最小。修正后的Allen公式具有很好的模型拟合（男女分别R2 = 0.88和R2 = 0.95, p<0.001），而经典公式对男女TBV的高估幅度均为30%。对于男性来说，身高对TBV计算的影响最大，而对于女性来说，体重是主要的决定因素。结论：通过Allen公式评估血容量或体重高估心脏手术患者的TBV，对其治疗有潜在的影响。MR经常表现为血管内体积增加的假设得到证实，而AS患者合并冠状动脉疾病的TBV相对较小。最后，一个改进的Allen公式，以更好地反映当今的患者群体，可重复地提高数学估计TBV的准确性。
Background: Total blood volume (TBV) assessment is central to the management of cardiac surgical patients with cardiopulmonary bypass (CPB). The widely accepted Allen Formula lacks accuracy in estimating TBV in these patients. Moreover, the impact of commonly encountered cardiac disease states on TBV has not been systematically investigated. The aim of this study was to determine TBV by hemodilution (TBVHD) for patients with valve disease, compare TBVHD to algorithms frequently used during cardiac surgery and to modify the Allen Formula to better fit today’s patient population. Methods: TBVHD was prospectively measured upon initiation of CPB. Ninety-six patients were grouped into 4 cohorts by preoperative diagnosis and compared to Allen and weight-based formulae in a univariate analysis: mitral regurgitation (MR), coronary artery disease requiring bypass surgery (CABG) and aortic stenosis (AS) ± CABG. The independent effects of height and weight on TBV were correlated to the original Allen Formula by multiple linear regression. Results: Patients with MR had significantly larger TBVHD compared to patients with AS, CABG or both. The smallest TBVHD was found in the patients with AS and CABG. The modified Allen Formula had an excellent model fit (R2 = 0.88 and R2 = 0.95 for males and females, respectively; p<0.001) while the classic formula overestimated TBV by 30% in males and females. For males, height impacted TBV calculations the most whereas weight was the predominant determinant in females. Conclusion: Blood volume assessment via the Allen Formula or bodyweight overestimated TBV in cardiac surgical patients, with potential implications on their management. The assumption that MR frequently presents with increased intravascular volume was confirmed whereas AS patients with coronary disease had a relatively smaller TBV. Lastly, a modified Allen Formula to better reflect today’s patient population was derived to reproducibly improve accuracy in mathematical estimates of TBV.