■体外循环(CPB)经常用于心脏手术,选择合适的灌注液是CPB的先决条件。目前,临床上常用的灌注液分为晶体和胶体,包括平衡的晶体,白蛋白,葡聚糖,明胶和羟乙基淀粉(HES)。该网络荟萃分析比较了成人CPB期间使用的八种液体的效果,以确定CPB手术过程中的最佳灌注液。
■在2023年4月13日之前发表的评估成人心脏手术中CPB灌注液的随机对照试验在OvidMEDLINE(R)ALL中进行了搜索,OVIDEMbase,和Cochrane中央控制试验登记册。各种灌注液分为八类,包括平衡的晶体,0.9%NaCl,等肿瘤人白蛋白,高致癌性人白蛋白,分子量为130k的HES,分子量为200k的HES,明胶和葡聚糖。
■血小板计数的NMA显示任何结果均无显著差异。在直接比较结果中,只有分子量为130k的HES与明胶(标准平均差=-0.40,95%置信区间[95CI:-0.63,-0.16)显示有显著差异。根据SUCRA,平衡晶体的血小板计数最高,其次是明胶,分子量为130k的HES具有最低的血小板,其次是分子量为200k的HES。
■使用葡聚糖的患者死亡率低,平均CPB时间短,使用平衡晶体在血小板计数方面是有益的,分子量为130k的HES有利于术后24h尿量。然而,所有的灌注液都有利弊,而灌注液的最佳选择仍然没有得到当前证据的支持。进行CPB手术时,在成人心脏手术中,应根据CPB的实际情况选择灌注液的类型。
当右旋糖酐用作CPB灌注液时,患者的死亡率最低,平均CPB时间最短.等致癌HA,患者ICU住院时间最短,手术后24h失血最少,术后24h胸管输出最低。使用平衡晶体有利于血小板计数,使用L-HES有利于术后24h的尿量,H-HES的使用导致住院时间最短。总之,这些液体中的每一种都有利弊,CPB手术中灌注液的最佳选择仍未得到当前证据的支持。进行CPB手术时,应根据患者身体的实际情况选择灌注液的类型。
Cardiopulmonary bypass (CPB) is frequently employed for cardiac surgery, and selecting a suitable priming fluid is a prerequisite for CPB. Currently, the commonly used priming fluids in clinics are classified as crystalloids and colloids, including balanced crystalloids, albumin, dextran, gelatin and hydroxyethyl starch (HES). This network meta-analysis compared the effects of eight fluids used during CPB in adults to determine optimal priming fluid during CPB surgery.
Randomised controlled trials assessing priming fluids for CPB in adult cardiac surgery published before 13 April 2023 were searched across Ovid MEDLINE(R) ALL, OVID EMbase, and Cochrane Central Register of Controlled Trials. Various priming fluids were classified into eight categories, including balanced crystalloids, 0.9% NaCl, iso-oncotic human albumin, hyperoncotic human albumin, HES with molecular weight 130k, HES with molecular weight 200k, gelatin and dextran.
The NMA of platelet counts revealed no significant differences in any result. In direct comparison results, only the comparison of HES with molecular weight 130k vs. gelatin (standard mean difference = -0.40, 95% confidence interval [95%CI: -0.63, -0.16) revealed a significant difference. According to the SUCRA, balanced crystalloids had the highest platelet count, followed by gelatin, and HES with a molecular weight of 130k had the lowest platelet, followed by HES with a molecular weight of 200k.
Patients using dextran have a low mortality rate and a short mean CPB time, the use of balanced crystalloids is beneficial in terms of platelet count, and HES with molecular weight 130k is beneficial for postoperative urine volume at 24h. However, all priming fluids have pros and cons quite, and the optimal choice of priming fluids remains unsupported by current evidences. When performing CPB surgery, the type of priming fluid should be selected according to the actual situation in CPB for adult cardiac surgery.
When dextran was used as the CPB priming fluid, patients had the lowest mortality and shortest mean CPB time.With iso-oncotic HA, patients had the shortest length of ICU stay, the least blood loss 24h after surgery, and the lowest chest tube output 24h after surgery.The use of balanced crystalloids was beneficial for platelet count, the use of L-HES was beneficial for urine output 24h after surgery, and the use of H-HES resulted in the shortest hospital stay.In summary, each of these fluids has pros and cons quite, and an optimal choice of priming fluids during CPB surgery remains unsupported by current evidence.When performing CPB surgery, the type of priming fluids should be selected according to the actual condition of the patient’s body.