PDF(Pubmed)
Abstract：
Cardiac surgery with cardiopulmonary bypass (CBP) is essential for different cardiac procedures in order to perform surgery with a clear sight field.To safely perform surgery with CPB and preserve brain, kidney, and patient tissue from ischemic damage, cold cardioplegia, and mild to deep hypothermia are induced during the operation.Cryoglobulinemia is a hematological/infective-related disease (in certain cases idiopathic) in which temperature-dependent antibodies tend to aggregate and form emboli in the vascular system causing tissue damage if exposed to low temperature.The patient with cryoglobulinemia (known and unknown) can be at risk of a major ischemic event during CPB and induced hypothermia.This article\'s aim is to evaluate the present scientific literature in order to understand how, in years, the therapeutic or preventive approach, is evolving, and to analyze and make improvements to the management of a cryoglobulinemic patient who must undergo elective or emergency cardiac surgery.In the last part of our article, we expose our single-center experience during a 32-month-long period of survey.In all cases, our medical team (anesthesiologists, perfusionists, and cardiac surgeons) opted for a normothermic cardiopulmonary bypass to lower the risk of cryoglobulin-associated complications.In our experience, along with therapeutic intervention to lower the cryoglobulin titer, normothermic management of cardiopulmonary bypass is as safe as hypothermic management.Notwithstanding our results, further studies with a larger population are needed to confirm this perioperative management in a cardiac surgery setting.
摘要：
体外循环（CBP）的心脏手术对于不同的心脏手术至关重要，以便以清晰的视野进行手术。为了安全地进行CPB手术并保护大脑，肾,和缺血性损伤的患者组织，冷心脏停搏液,手术期间会诱发轻度到深低温。冷球蛋白血症是一种血液学/感染相关疾病（在某些情况下是特发性），其中温度依赖性抗体在暴露于低温时会在血管系统中聚集并形成栓子，从而导致组织损伤。患有冷球蛋白血症（已知和未知）的患者在CPB和诱导的低体温期间可能有发生重大缺血事件的风险。本文的目的是评估当前的科学文献，以了解如何，多年来,治疗或预防方法，正在进化，并分析和改进必须接受择期或急诊心脏手术的冷球蛋白血症患者的管理。在我们文章的最后一部分,我们在为期32个月的调查中揭露了我们的单中心经验。在所有情况下,我们的医疗团队(麻醉师，灌注主义者,和心脏外科医生）选择了常温体外循环以降低冷球蛋白相关并发症的风险。根据我们的经验,随着治疗干预降低冷球蛋白滴度，体外循环的常温管理与低温管理一样安全。尽管我们的结果，需要对更多人群进行进一步研究,以确认心脏手术的围手术期处理.
