摘要
目的:比较非体外循环(off-pump)和体外循环(on-pump)冠状动脉旁路移植手术(CABG)围术期的输血量和凝血功能。方法:187例患者接受CABG手术,其中105例采用off-pump,82例采用传统的on-pump,回顾性地收集两组患者术前PT、PT国际标准化比值(INR)、FIB和APTT、手术时间、旁路移植血管数、ICU留住时间、再次开胸止血的病例数、术后24h胸腔引流量、围术期输入血制品的量及血常规指标。结果:两组患者的一般情况和术前凝血情况相似,但与off-pump患者相比,on-pump患者手术结束时的Hb、Hct和血小板数量显著减少,术后24h胸腔引流量、再次开胸止血的例数和围术期输入血液制品的量明显增加。结论:off-pumpCABG可避免CPB本身引起的血液稀释、血小板数量减少等引起的凝血功能异常,从而减少围术期出血和血液制品用量,缩短ICU时间,节省医疗费用。
Objective: To compare the perioperative coagulation and transfusion between on-pump and off-pump patient undergoing coronary artery bypass grafting(CABG). Methords: Data were retrospectively collected from 187 consecutive patients who underwent primary coronary artery bypass grafting. On the basis of type of surgery, patients were divided into on-pump(82) and off-pump(105) CABG. Outcome measures included duration of operation, number of grafts, time of ICU stay, number of chest re-exploration, postoperative drainage from chest tubes in first 24h period, perioperative hemoglobin(Hb), hemoglobin concentrations(Hct), platelet count, coagulation parameters, and transfusion requirements. Results: There were no differences in demographic data, surgical characteristics and preoperative coagulation profile in two groups. However, Hb, Hct and platelets decreased more in the on-pump group, and the off-pump group had less postoperative bleeding, less rate of chest re-exploration and required fewer blood products compared with the on-pump group. Conclusion: The results indicated that patients undergoing off-pump CABG have lower transfusion rates,which may be due to better preservation of platelets and less dilution coagulopathy.
出处
《陕西医学杂志》
CAS
北大核心
2005年第6期652-655,共4页
Shaanxi Medical Journal
基金
第四军医大学金桥工程基金资助项目(NO.01015)
第四军医大学西京医院创新课题资助(NO.200238
