Comparative study of microfibrillar collagen hemostat (Colgel) and oxidized cellulose (Surgicel) in high transfusion-risk cardiac surgery.
Comparative study of microfibrillar collagen hemostat (Colgel) and oxidized cellulose (Surgicel) in high transfusion-risk cardiac surgery.
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DOI：
10.1016/s0022-5223(03)00042-4
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发表时间：
2003-09
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通讯作者：
M. Şırlak;S. Eryılmaz;L. Yazıcıoğlu;U. Kızıltepe;Z. Eyileten;Mustafa Serkan Durdu;Refik Taşoz;N. T. Eren;Atilla Aral;B. Kaya;H. Akalin
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作者：
M. Şırlak;S. Eryılmaz;L. Yazıcıoğlu;U. Kızıltepe;Z. Eyileten;Mustafa Serkan Durdu;Refik Taşoz;N. T. Eren;Atilla Aral;B. Kaya;H. Akalin
目的比较微纤胶原止血剂(科尔凝胶)和氧化纤维素(Surgicel)在心脏手术中对出血和异体输血的影响。方法1999年8月至2001年11月，71例择期高危出血患者在知情同意后接受手术。这些手术包括重复的心脏手术(主动脉-冠状动脉搭桥术或瓣膜手术)，需要深低温停循环的升主动脉瘤修补术，以及不需要深低温停循环的升主动脉移植。如果受试者最近(5天)摄入乙酰水杨酸，接受溶栓治疗或抗凝治疗(术前4小时肝素或术前3天华法林)，则排除这些受试者。结果COLGEL组术后24小时胸腔引流液量为373±143毫升，外科手术组为571±144毫升(P=.01)。术后胸腔引流液组为423±154m L(280~1100 m L)，外科手术组为677±128 m L(285~1350 m L)(P=0.01)。术后每隔3h比较两组胸腔引流情况。术后前3小时的出血量科尔胶组明显少于对照组(132±41比228±57毫升，P<0.01)。在接下来的3小时内，这一差异持续存在(67±24比121±49毫升，P<；.001)。结论微纤维胶原粉使用方便、成本低、有明显的止血作用，对于有较高出血风险的心脏手术具有吸引力。
OBJECTIVEThe effects of microfibrillar collagen hemostat (Colgel) and oxidized cellulose (Surgicel) on bleeding and allogeneic transfusions were compared in cardiac operations with a predicted high risk of bleeding.METHODSBetween August 1999 and November 2001, 71 patients undergoing elective, high risk of bleeding operations were studied after giving informed consent. The procedures included repeat cardiac operations (aorta-coronary bypass operations or valvular operations), ascending aortic aneurysm repair necessitating deep hypothermic circulatory arrest, and ascending aortic grafting without deep hypothermic circulatory arrest. Subjects were excluded if they had recent (<5 days) acetylsalicylic acid ingestion, thrombolytic therapy, or anticoagulant therapy (heparin <4 hours preoperatively or warfarin <3 days preoperatively). Consenting subjects were randomized to receive either Colgel or Surgicel.RESULTSChest tube drainage in the first 24 hours was 373 ± 143 mL in the Colgel group and 571 ± 144 mL in the Surgicel group (P = .01). Total postoperative chest tube drainage was 423 ± 154 mL (range, 280-1100 mL) in the Colgel group and 677 ± 128 mL (range, 285-1350 mL) in the Surgicel group (P = .01). In addition, chest tube drainage was compared between the 2 groups every 3 hours after operation. Blood loss in the first 3 postoperative hours was significantly less in the Colgel group (132 ± 41 vs 228 ± 57 mL, P < .001). In the following 3-hour interval, this significant difference persisted (67 ± 24 vs 121 ± 49 mL, P < .001).CONCLUSIONSIn conclusion, the easy application, low cost, and significant blood-loss reduction effect of microfibrillar collagen powder renders this agent attractive for cardiac operations associated with high risk of bleeding.