体外循环(CPB)使幼儿容易患凝血病。作者评估了CPB灌注液对小儿心脏手术围手术期出血的可能影响。
以前发表的研究的荟萃分析和系统评价。
各项研究均在外科中心或重症监护病房进行。
纳入调查18岁以下无基础血液系统疾病患者的研究。
作者评估了1980年至2020年在MEDLINE上发表的随机对照试验(RCT),EMBASE,PubMed,和中央数据库。主要结果是术后出血;次要终点包括输血,死亡率,和安全。
分析了20个合格的随机对照试验,共有1,550名患者,每个研究的中位数为66名患者(范围为20-200)。最常评估的干预措施是将新鲜冷冻血浆(FFP)添加到prime(8/20),其次是白蛋白(5/20),人造胶体(5/20),和基于血液的引发溶液(3/20)。对771名患者的10项研究以mL/kg为单位评估了24小时的失血量,并纳入了荟萃分析。他们中的大多数研究了向灌注液中添加FFP(7/10)。干预组与对照组比较差异无统计学意义。平均差为-0.13(-2.61至2.34),p=0.92,I2=69%。描述了进一步的研究终点,但他们的报告过于异质,无法进行定量分析。
对当前证据的系统评价未显示不同的CPB引发溶液对24小时失血的影响。分析受到数据集中关于人口的异质性的限制,干预类型,给药,和选择的比较器,损害任何结论。
Cardiopulmonary bypass (CPB) predisposes young children to coagulopathy. The authors evaluated possible effects of CPB priming fluids on perioperative bleeding in pediatric cardiac surgery.
Meta-analysis and systematic
review of previously published studies.
Each study was conducted in a surgical center or intensive care unit.
Studies investigating patients <18 years without underlying hematologic disorders were included.
The authors evaluated randomized controlled trials (RCTs) published between 1980 and 2020 on MEDLINE, EMBASE, PubMed, and CENTRAL databases. The primary outcome was postoperative bleeding; secondary endpoints included blood product transfusion, mortality, and safety.
Twenty eligible RCTs were analyzed, with a total of 1,550 patients and a median of 66 patients per study (range 20-200). The most frequently assessed intervention was adding fresh frozen plasma (
FFP) to the prime (8/20), followed by albumin (5/20), artificial colloids (5/20), and blood-based priming solutions (3/20). Ten studies with 771 patients evaluated blood loss at 24 hours in mL/kg and were included in a meta-analysis. Most of them investigated the addition of
FFP to the priming fluid (7/10). No significant difference was found between intervention and control groups, with a mean difference of -0.13 (-2.61 to 2.34), p = 0.92, I2 = 69%. Further study endpoints were described but their reporting was too heterogeneous to be quantitatively analyzed.
This systematic
review of current evidence did not show an effect of different CPB priming solutions on 24-hour blood loss. The analysis was limited by heterogeneity within the dataset regarding population, type of intervention, dosing, and the chosen comparator, compromising any conclusions.