Do collagen-impregnated knitted Dacron grafts reduce the need for transfusion in infrarenal aortic reconstruction?
Do collagen-impregnated knitted Dacron grafts reduce the need for transfusion in infrarenal aortic reconstruction?
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胶原蛋白浸渍的针织涤纶移植物是否可以减少肾下主动脉重建中的输血需求？
DOI：
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发表时间：
1995
影响因子：
1.5
通讯作者：
J. Gournier
中科院分区：
文献类型：
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作者：
X. Barral;J. Gay;J. Favre;J. Gournier
本研究的目的是评价胶原浸渍的涤纶移植物在接受肾下主动脉重建的患者中的受益。因此，我们前瞻性地比较了1991年1月至1992年12月期间接受Dacron移植物肾下主动脉重建术的两个连续系列的患者。第一组（A组）包括83个高密度针织假体移植物（Dialine I），而第二组包括82个相同类型但浸渍胶原蛋白的移植物（Dialine II）。两组在年龄、性别和手术风险因素方面具有可比性。在闭塞性疾病或动脉瘤的患者比例方面也相当，即A组和B组分别有39例和36例闭塞性疾病患者以及44例和46例动脉瘤患者。两组的旁路类型相似，A组和B组分别插入17和19根管状移植物以及66和63根分叉移植物。研究并比较了每组内的13个参数，包括（1）感染移植物数量，（2）术后闭塞数量，（3）术后最高温度，（4）术后血培养阳性数量，（5）术后死亡数量，（6）术中和（7）术后输血量，（8）术前和术后血红蛋白浓度之间的差异，（9）术前和术后纤维蛋白原水平之间的差异，（10）术前和术后血小板计数之间的差异，（11）主动脉阻断的持续时间，（12）肠功能恢复的日期，和（13）术前和术后住院的平均持续时间。在A组中观察到1例死亡、1例移植物闭塞和1例术后感染，而在B组中观察到3例死亡、2例闭塞和1例术后感染（差异不显著）。在研究的所有参数中，唯一显著差异是植入胶原浸渍移植物时单位输血需求的减少（p<0.05）。这些结果与其他标准或胶原蛋白涂层编织移植物观察到的结果相似。失血量少，导致病毒污染的理论风险降低，这似乎是胶原蛋白涂层移植物的主要优点。
The purpose of this study was to evaluate the benefits of collagen-impregnated Dacron grafts in patients undergoing infrarenal aortic reconstruction. We therefore prospectively compared two consecutive series of patients undergoing infrarenal aortic reconstruction with Dacron grafts between January 1991 and December 1992. The first group (group A) included 83 high-density knitted prosthetic grafts (Dialine I), whereas the second included 82 grafts of the same type but impregnated with collagen (Dialine II). The two groups were comparable with regard to age, sex, and operative risk factors. They were also comparable in terms of the proportion of patients with occlusive disease or aneurysms, that is, there were 39 and 36 patients with occlusive disease and 44 and 46 patients with aneurysms in groups A and B, respectively. The type of bypass was similar in both groups with 17 and 19 tubular grafts and 66 and 63 bifurcated grafts being inserted in groups A and B, respectively. Thirteen parameters were studied and compared within each group including (1) number of infected grafts, (2) number of postoperative occlusions, (3) maximum postoperative temperature, (4) number of positive postoperative blood cultures, (5) number of postoperative deaths, (6) intraoperative and (7) postoperative quantities of blood transfused, (8) difference between pre- and postoperative hemoglobin concentrations, (9) difference between pre- and postoperative fibrinogen levels, (10) difference between pre- and postoperative platelet counts, (11) duration of aortic clamping,(12) date of return of intestinal function, and (13) mean duration of pre- and postoperative hospital stays. One death, one graft occlusion, and one postoperative infection were observed in group A, whereas there were three deaths, two occlusions, and one postoperative infection in group B (difference not significant). Of all the parameters studied, the only significant difference concerned the reduction in transfusion requirements of units when a collagen-impregnated graft was inserted (p<0.05). These results are similar to those observed with other standard or collagen-coated knitted grafts. Less loss of blood, resulting in a reduced theoretic risk of viral contamination, appears to be the main advantage of collagen-coated grafts.