【罂粟摘要】输注平衡液-胶体能否减少小儿心脏手术围手术期出血量？：一项随机对照双盲试验
输注平衡液-胶体能否减少小儿心脏手术围手术期出血量？：一项随机对照双盲试验
贵州医科大学高鸿教授课题组
翻译：佟睿 编辑：佟睿 审校：曹莹
非平衡液会导致患儿代谢性酸中毒，并可能与凝血功能受损和失血量增加有关。
探讨行心脏手术的患儿在围手术期使用平衡液-胶体方案与生理盐水-胶体方案进行液体治疗与减少围术期失血量和血液制品暴露的相关性。
随机、对照、双盲试验。
从2013年到2016年在三级儿童医院进行手术的患儿。
纳入日龄大于29天及年龄小于3岁的接受体外循环(CPB)心脏手术的患儿。排除标准为急诊心脏手术、奄奄一息状态(按照美国麻醉学家协会5评估指标)、凝血障碍、肾功能衰竭、肝损伤、颅内出血和电解质紊乱。在128名符合条件的患儿中，筛选了88名纳入这项研究。
将患者随机分配到生理盐水-胶体方案组(6%羟乙基淀粉130/0.4溶于0.9%NaCl中)或平衡液-胶体方案组(6%羟乙基淀粉130/0.4溶于平衡液中)，作为患儿在体外循环预充、术中及术后的液体治疗方案。
主要观察指标是计算术后第三天的出血量(POD3)。
每组研究共纳入了44名患者。术后第3天计算失血量，生理盐水-胶体方案与平衡液-胶体方案比较，差异无统计学意义（19.9ml·kg-1 vs. 15.9ml·kg-1, [IQR 9.0~25.3ml·kg-1], P=0.409)。两组之间的次要观察指标包括与出血、血液制品暴露和凝血有关的指标没有差异。两组在机械通气时间、重症监护时间和住院时间方面也没有差异。
与生理盐水相比，使用平衡液-胶体方案进行围手术期液体治疗不会减少患儿失血量或血液制品暴露。
Ariane Willems, Françoise De Groote, Denis Schmartz, et al. Does a balanced colloid decrease perioperative blood loss in paediatric cardiac surgery: A double-blinded randomized controlled trial?.[J].Eur J Anaesthesiol 2021; 38:923–931.
Does a balanced colloid decrease perioperative blood loss in paediatric cardiac surgery: A double-blinded randomized controlled trial?
Abstract
BACKGROUND Unbalanced fluid solutions cause metabolic acidosis and could be associated with impaired coagulation and increased blood loss.
OBJECTIVE To investigate whether the use of a balanced colloid compared with a saline colloid for peri-operative fluid therapy in children undergoing cardiac surgery is associated with decreased blood loss and exposure to blood products.
DESIGN Double-blinded randomised controlled trial.
SETTING Tertiary children’s hospital from 2013 to 2016.
PATIENTS Children older than 29 days and younger than 3 years admitted for cardiac surgery with cardiopulmonary bypass (CPB). Exclusion criteria were emergency cardiac surgery, moribund (American Society of Anesthesiologists 5), Jehovah’s witnesses, coagulopathy, renal failure, liver injury, intracranial haemorrhage and electrolyte disturbances. From the 128 patients eligible, 88 were included in the study.
INTERVENTION Random assignment of patients to either a saline colloid (6% hydroxyethyl starch 130/0.4 in 0.9% NaCl) or a balanced-electrolyte colloid (6% hydroxyethyl starch 130/0.4 in an isotonic solution) for CPB priming and intra- and postoperative fluid therapy during the first postoperative 48 h.
MAIN OUTCOME MEASURE The primary outcome measure was calculated blood loss until the third postoperative day (POD3).
RESULTS A total of 44 patients were included in each study arm. Calculated blood loss at POD3 was not significantly different between the groups (saline colloid 19.9 [IQR 13.8 to 26.1]ml kg-1 versus balanced colloid 15.9 [IQR 9.0 to 25.3 ml kg-1], P=0.409). Secondary outcomes related to bleeding, exposure to blood products and coagulation were not different between groups. There was also no difference in length of mechanical ventilation, intensive care and hospital length of stay between groups.
CONCLUSION The use of a balanced colloid for peri-operative fluid therapy compared with a saline one is not associated with decreased blood loss or exposure to blood products.
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