Blood transfusion is associated with prolonged duration of mechanical ventilation in infants undergoing reparative cardiac surgery.
Blood transfusion is associated with prolonged duration of mechanical ventilation in infants undergoing reparative cardiac surgery.
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DOI：
10.1097/pcc.0b013e3181e30d43
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发表时间：
2011-01
期刊：
影响因子：
--
通讯作者：
Newburger JW
中科院分区：
文献类型：
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作者：
Kipps AK;Wypij D;Thiagarajan RR;Bacha EA;Newburger JW
围术期输血对接受心脏手术的成年人有不良影响。我们试图调查更多地使用血液和血液制品是否可能是婴儿修复性心脏手术后机械通气时间(DMV)所指示的术后恢复时间延长的独立预测因素。对270例婴幼儿心脏手术体外循环期间红细胞压积策略的前瞻性随机试验资料进行分析，以探讨DMV与围手术期输血量及其他变量的关系。在单变量分析中，较长的DMV与较年轻的年龄和较低的手术体重、诊断组以及较高的术中和术后输血量(各0.001)相关。在多变量比例风险回归分析中，较长的总支持时间和较大的术中和术后早期每公斤产血量是DMV延长的最强预测因素。术中每公斤产血量最高的三分位数的患者立即拔管的风险约为最低三分位数的患者的一半(风险比=0.51，95%可信区间0.35，0.73)。术后第1天接受任何血液制品的患者与未接受血液制品的患者相比，拔管的风险比为0.65(95%CI为0.50，0.85)。在这项探索性二次分析中，对无主动脉弓梗阻的先天性心脏病行双室修补术的婴儿，术中和术后早期输血较多是导致DMV延长的潜在重要危险因素。未来需要进行前瞻性临床试验，以确定减少血液制品给药是否会加速婴儿心脏手术后的恢复。
Perioperative transfusion has adverse effects in adults undergoing cardiac surgery. We sought to investigate whether greater use of blood and blood products might be an independent predictor of prolonged postoperative recovery, indicated by duration of mechanical ventilation (DMV), after reparative infant heart surgery. Prospectively collected data on 270 infants from two randomized trials of hematocrit strategy during cardiopulmonary bypass in infant heart surgery were analyzed to explore the association of DMV with perioperative transfusion and other variables. In univariable analyses, longer DMV was associated with younger age and lower weight at surgery, diagnostic group, and higher intraoperative and postoperative blood product transfusion (each p<0.001). In multivariable proportional hazard regression, longer total support time and greater intraoperative and early postoperative blood products per kg were the strongest predictors of longer DMV. Patients in the highest tertile of intraoperative blood products per kg had an instantaneous risk of being extubated approximately half that of patients in the lowest tertile (hazard ratio=0.51, 95% CI 0.35, 0.73). Patients who received any blood products postoperative day 1, compared to those who did not, had a hazard ratio for extubation of 0.65 (95% CI 0.50, 0.85). In this exploratory secondary analysis of infants undergoing two ventricular repair of congenital heart disease without aortic arch obstruction, greater intraoperative and early postoperative blood transfusion emerged as potential important risk factors for longer DMV. Future prospective clinical trials are needed to determine whether reduction in blood product administration hastens postoperative recovery after infant heart surgery.