【罂粟摘要】 心脏手术中术前血浆纤维蛋白原水平与围手术期严重出血之间的U型关系

心脏手术中术前血浆纤维蛋白原水平与

围手术期严重出血之间的U型关系

背景

在心脏手术中，术前纤维蛋白原水平与术后失血量之间存在负线性关系。然而，最近也有术前纤维蛋白原水平高与输血和再次手术有关的报道。

目的

我们验证了以下假设，即术前纤维蛋白原水平与围手术期严重出血之间的关系不是线性的。

实验设计

一项大规模（n=3883）单中心回顾性研究。

范围设置

三级教学医院。

研究对象

我们分析了机构数据库中的数据，其中包括2010年9月至2014年5月之间通过胸骨切开进行体外循环心脏手术的所有18岁以上患者。

主要观察指标

根据《围手术期出血全球定义》中所定义的第3或第4类，确定是否为围手术期大出血。通过二元逻辑回归分析术前纤维蛋白原水平与围手术期严重出血之间的关系。三次B样条曲线变换用于估计术前纤维蛋白原水平与围手术期大量出血之间的相关性。

结果

957例（24.6％）患者观察到严重的围手术期出血。术前纤维蛋白原水平与术后24h失血之间呈L型关系。术前纤维蛋白原水平与严重围手术期出血（即围手术期出血为3或4级）之间的关系呈U形：曲线开始向上倾斜时，围手术期严重出血的风险降至3.3 g·L^-1在5.8 g·L^-1处上升，而在8.2 g·L^-1以上则急剧增加。

结论

严重的围手术期出血与术前纤维蛋白原水平之间呈U型关系。虽然低水平的纤维蛋白原似乎与出血的高风险有关，但是高水平的纤维蛋白原并不一定能使患者免受这种风险的影响，甚至可能是围手术期出血的危险因素。

原始文献来源：

Mion S, Duval B, Besnard T, et,al.U-shaped relationship between pre-operative plasma fibrinogen levels and severe peri-operative bleeding in cardiac surgery[J].Eur J Anaesthesiol 2020 10;3710(10) DOI：10.1097/EJA.0000000000001246

READING

U-shaped relationship between pre-operative plasma fibrinogen levels and severe peri-operative bleeding in cardiac surgery

BACKGROUND： An inverse linear relationship has been reported between pre-operative fibrinogen levels and post-operative blood loss in cardiac surgery. However, recently high pre-operative fibrinogen levels have also been reported to be associated with increased blood transfusion and re-operation.

OBJECTIVE： We tested the hypothesis that the relationship between pre-operative fibrinogen levels and severe peri-operative bleeding is not linear.

DESIGN： A large-scale (n=3883) single-centre retrospective study.

SETTING： A tertiary care teaching hospital.

PATIENTS： We analysed data from our institutional database which includes all patients above 18 years who underwent on-pump cardiac surgery through a sternotomy between September 2010 and May 2014.

MAIN OUTCOME MEASURES： Peri-operative severe bleeding adapted from the Universal Definition of Peri-operative Bleeding, class 3 or 4. The relationship between pre-operative fibrinogen levels and peri-operative severe bleeding was analysed by binary logistic regression. A cubic B-spline transformation was used to estimate the relationship between pre-operative fibrinogen level associated with excessive peri-operative bleeding.

RESULTS： Severe peri-operative bleeding was observed in 957 (24.6%) patients. An L-shaped relationship was observed between pre-operative fibrinogen levels and 24h postoperative blood loss. The relationship between pre-operative fibrinogen levels and severe peri-operative bleeding (i.e. Universal Definition of Peri-operative Bleeding class 3 or 4) was U-shaped: the risk of severe peri-operative bleeding bottomed at 3.3 g l^-1when the upward sloping curve started at 5.8 g l^-1with a steeper increase above 8.2 g l^-1.

CONCLUSION： We reported a U-shaped relationship between severe peri-operative bleeding and pre-operative fibrinogen levels. While a low-level of fibrinogen appears to be associated with a high risk of bleeding, a high level does not necessarily protect the patient against such a risk and could even be a risk factor for peri-operative bleeding.

翻译：牛振瑛    编辑：佟睿    审校：曹莹