背景:在心脏手术中,使用体外循环(CPB)几乎是不可避免的。然而,会引起并发症,包括溶血。直到现在,没有任何减少CPB溶血的标准.因此,本系统综述旨在确定CPB使用中增加或减少溶血的因素.
方法:1990-2021年在PubMed数据库和CochraneCENTRAL上进行了关键词Earches(心脏手术和体外循环和溶血),用于研究CPB干预措施的已发表的随机对照试验(RCT)。在心脏手术患者中,并测量溶血作为结果之一。涉及术前血液病患者的研究,人工瓣膜,术前使用主动脉内球囊泵和体外循环,紧急和微创手术被排除结果:搜索产生了64项符合纳入标准的研究,总共涉及3,434名患者。最常见的手术是冠状动脉血运重建(75%)。在64项研究中,33分为7个分析。其余31项研究进行了定性合成。在PFHb(p=0.0006)和Hp(p<0.0001)结果的离心泵与滚子泵中发现了显着下降,分离血液与合并抽吸血液(p=0.003),CPB替代方案与常规CPB(p<0.0001),和小型体外循环(MiniECC)与传统CPB治疗LDH(p=0.0008)。与重力辅助静脉引流(GAVD)相比,搏动性(p=0.03)和真空辅助静脉引流(VAVD)显着增加(p=0.002)。
结论:该综述显示溶血可能是由多种因素引起的,并已努力减少溶血,结合重大努力可能是有益的。然而,这篇评论有局限性,例如由于没有可用于进行CPB的标准而导致的异质性。因此,需要采用CPB标准化指南进行进一步研究,以获得更多可比较的研究.应进行具有更具体参数的荟萃分析,以最大程度地减少异质性。
BACKGROUND: The use of cardiopulmonary bypass (CPB) is almost inevitable in cardiac surgery. However, it can cause complications, including hemolysis. Until now, there have not been any standards for reducing hemolysis from CPB. Therefore, this systematic
review was conducted to determine the factors that increase or reduce hemolysis in the use of CPB.
METHODS: Keywords Earches (cardiac surgery AND cardiopulmonary bypass AND hemolysis) were done on PubMed databases and Cochrane CENTRAL from 1990-2021 for published randomized controlled trials (RCTs) that studied interventions on CPB, in cardiac surgery patients, and measured hemolysis as one of the outcomes. Studies involving patients with preoperative hematological disorders, prosthetic valves, preoperative use of intra-aortic balloon pumps and extracorporeal circulation, emergency and minimally invasive surgery are excluded RESULTS: The search yielded 64 studies that met the inclusion criteria, which involved a total of 3,434 patients. The most common surgery was coronary revascularization (75%). Out of 64 studies, 33 divided into 7 analyses. Remaining 31 studies were synthesized qualitatively. Significant decreases were found in centrifugal vs roller pumps for PFHb (p = 0.0006) and Hp (p < 0.0001) outcomes, separated vs combined suctioned blood (p = 0.003), CPB alternatives vs conventional CPB (p < 0.0001), and mini extracorporeal circulation (MiniECC) vs conventional CPB for LDH (p = 0.0008). Significant increases were found in pulsatility (p = 0.03) and vacuum-assisted venous drainage (VAVD) vs gravity-assisted venous drainage (GAVD) (p = 0.002).
CONCLUSIONS: The
review shows that hemolysis could be caused by several factors and efforts have been made to reduce it, combining significant efforts could be beneficial. However, this
review has limitations, such as heterogeneity due to no standards available for conducting CPB. Therefore, further research with standardized guidelines for CPB is needed to yield more comparable studies. Meta-analyses with more specific parameters should be done to minimize heterogeneity.