【罂粟摘要】明胶与心脏术后出血风险
明胶与心脏术后出血风险
贵州医科大学 高鸿教授课题组
翻译：马艳燕 修改：佟睿 编辑：佟睿 审校：曹莹
因为明胶比晶体液能更好地维持血管内容量，所以在心脏外科手术较常应用。不幸的是，明胶与凝血和止血功能受损有关，这可能会导致术后出血量增加。我们研究了明胶是否会增加心脏手术后的出血量。
我们在一所三级教学医院重症监护病房进行了回顾性、观察性单中心队列研究。比较两组术后出血量、胸管引流量及血制品消耗量。
本研究共纳入了3067例接受心脏手术的患者。其中1698例患者接受明胶治疗(明胶组)，1369例患者不接受明胶治疗(晶体组)。明胶组和晶体组患者的特征具有可比性。与晶体组相比，明胶组术后12小时胸管引流增加了18% (95% CI 11% - 20%)，术后24小时胸管引流增加了15% (95% CI 7% - 17%)。明胶组术后严重大出血的发生率高于晶体组(21% vs 16%， P<0.001)。明胶组患者输注红细胞(40% vs 20%， P<0.001)和血小板(12% vs 8%， P<0.001)的频率高于晶体组。然而，新鲜冰冻血浆输注量在两组之间没有差异。
明胶可能会增加心脏手术后的出血量和输血的需求。
Koponen T, Musialowicz T, Lahtinen P，et al. Gelatin and the risk of bleeding after cardiac surgery. Acta Anaesthesiol Scand. 2020 Nov;64(10):1438-1445.
Gelatin and the risk of bleeding after
cardiac surgery
Abstract
Background: Gelatin have been used in cardiac surgery because of their ability to preserve intravascular volume better than crystalloids. Unfortunately, gelatin have been associated with impaired coagulation and hemostasis, that may cause increased bleeding. We investigated whether the administration of gelatin increases postoperative bleeding after cardiac surgery.
Methods: Retrospective, observational single-center cohort study in the intensive care unit of a tertiary teaching hospital. Postoperative bleeding, chest tube drainage volume and consumption of blood products was compared between groups.
Results: Cohort included 3067 consecutive patients who underwent cardiac surgery. First 1698 patients received gelatin (gelatin group), and 1369 patients did not (crystalloid group). The characteristics of the patients in the gelatin and crystalloid groups were comparable. Postoperative chest tube drainage was 18% (95% CI 11 to 20%) greater during the first 12 hours (P<0.001) and 15% (95% CI 7 to 17%) greater during the first 24 hours (P<0.001) in the gelatin group compared to the crystalloid group. Severe and massive postoperative bleeding was more common in the gelatin group compared to the crystalloid group (21 vs. 16%, P<0.001). Patients in the gelatin group received red blood cells (40 vs. 20%, P<0.001) and platelets (12 vs. 8%, P<0.001) more frequently than patients in the crystalloid group. However, the number of administered fresh-frozen plasma transfusions did not differ between the groups.
Conclusion: Gelatin may increase postoperative bleeding and the need for blood product transfusions after cardiac surgery.
翻译：马艳燕
修改：佟睿
编辑：佟睿
审校：曹莹
贵州医科大学高鸿教授课题组