Management of Intraoperative Fluid Balance and Blood Conservation Techniques in Adult Cardiac Surgery
Management of Intraoperative Fluid Balance and Blood Conservation Techniques in Adult Cardiac Surgery
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DOI：
10.1532/hsf98.2010111
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发表时间：
2011-02-01
影响因子：
0.6
通讯作者：
Karanikolas, Menelaos
中科院分区：
文献类型：
--
作者：
Vretzakis, George;Kleitsaki, Athina;Karanikolas, Menelaos
输血与不良生理效应和增加成本相关，因此手术期间减少血液制品的使用是所有患者的理想目标。心脏手术是捐献血液制品的主要消费者，特别是在使用体外循环（CPB）时，因为在体外循环期间，由于失血和血细胞稀释，血细胞比容急剧下降。心血管麻醉医师学会最近发表的一份报告将高龄、术前红细胞容量低（术前贫血或体型较小）、术前抗血小板或抗血栓药物、复杂或再次手术或紧急手术以及患者合并症等视为重要的输血风险指标。该报告还确定了一些可能有助于减少输血的术前和术中干预措施，包括非体外循环手术、术前自体献血、正常容量血液稀释和常规细胞保存剂的使用。采用多模式血液保存方法，让高危患者接受所有可用的干预措施，可能有助于保护重要器官灌注并减少血液制品的利用率。此外，由于静脉液体正平衡是影响心脏手术期间血液稀释的重要因素，特别是在使用体外循环时，旨在限制术中液体平衡阳性的策略也可能导致血液制品利用率的降低。这篇综述讨论了目前可在术中使用的技术，试图避免或最小化液体平衡阳性，以保护患者自身的红细胞，并减少心脏手术期间血液制品的利用率。
Blood transfusions are associated with adverse physiologic effects and increased cost, and therefore reduction of blood product use during surgery is a desirable goal for all patients. Cardiac surgery is a major consumer of donor blood products, especially when cardiopulmonary bypass (CPB) is used, because hematocrit drops precipitously during CPB due to blood loss and blood cell dilution. Advanced age, low preoperative red blood cell volume (preoperative anemia or small body size), preoperative antiplatelet or antithrombotic drugs, complex or re-operative procedures or emergency operations, and patient comorbidities were identified as important transfusion risk indicators in a report recently published by the Society of Cardiovascular Anesthesiologists. This report also identified several pre- and intraoperative interventions that may help reduce blood transfusions, including off-pump procedures, preoperative autologous blood donation, normo-volemic hemodilution, and routine cell saver use.A multimodal approach to blood conservation, with high-risk patients receiving all available interventions, may help preserve vital organ perfusion and reduce blood product utilization. In addition, because positive intravenous fluid balance is a significant factor affecting hemodilution during cardiac surgery, especially when CPB is used, strategies aimed at limiting intraoperative fluid balance positiveness may also lead to reduced blood product utilization.This review discusses currently available techniques that can be used intraoperatively in an attempt to avoid or minimize fluid balance positiveness, to preserve the patient's own red blood cells, and to decrease blood product utilization during cardiac surgery.