Effects Of Cell Saver On Coagulation And Inflammatory Markers In Cardiac Surgery With Cardiopulmonary Bypass

Objective To evaluate the effects of cell saver system on coagulation and inflammatory markers in cardiopulmonary bypass(CPB)cardiac surgical procedures.Method The study is a randomized controlled clinical trial.120 patients who received CPB-assisted heart surgery in our hospital from Match to October of 2014 were selected,and they were randomly distributed into autologous blood cell salvage(CS)group(60 cases)and non-cell salvage(C0)group(60 cases).Each group was divided into 3 subgroups according to Cardiopulmonary Bypass(CPB)auxiliary time,which were long time CPB(L)group(CPB time>120min),medium time CPB(M)group(60min<CPB time?120min)and short time CPB(S)group(CPB time?60min)with 20 cases for each subgroup.During the surgery,autologous blood cell salvage(CS)group turned off the CPB machine protamine anti-heparin before the pipeline congestion of CPB machine and surgical field bleeding were filtrated,washed,concentrated and reinfused to patients by Haemonetics Cell Saver 5 recovery system;while for the C0 group,the pipeline congestion of machine was kept directly in storage bag for intravenous reinfusion after turning off the machine.Blood test as well as routine coagulation test were carried out at preoperative test,1h,6h,24 h,48h after endpoint of CPB,and simultaneously Point extracted central venous blood was detected with ELESA to determine inflammatory cytokines Index such as TNF-a,IL-6,IL-10 and so on.Intraoperative blood loss,postoperative mediastinal and pericardial drainage,extubation time,ICU residence time and mortality rate within one month after surgery were observed.Perioperative period patients transfused with allogeneic blood,number of blood products and transfusion-related adverse reactions were recorded.Result The general information of patients before surgery showed no difference.3 different CPB time subgroups from autologous blood recovery group demonstrated differences in autologous blood,and the differences were significant(p<0.05).the short time CPB group was 419.1±71.41 m,medium time CPB group was 489.25±105.62 ml,and the long time CPB group was 594.31±111.73ml?The average volume infusion of allogeneic packed red blood cells,fresh frozen plasma and platelets from 3 different time CPB groups were compared,and the long time CPB group was significantly higher than the short time group(p<0.05).Compared with C0 group,the proportion of infusion of allogeneic red blood cells in CS group was significantly lower,a significant difference(p<0.05).In terms of postoperative mediastinum and pericardial drainage,drainage volumes of medium time CPB group and long time CPB group at 24 h and 72 after surgery were significantly higher than short time CPB group(p<0.05).Postoperative drainage between CS group and C0 group illustrated insignificant difference(p>0.05).All patients' cardiopulmonary bypass and IL-6,IL-10 and TNF-? concentrations after turning off the machine were significantly raised(p<0.05).Patients from long time CPB group at 6h and 24 h after turning off the machine demonstrated higher concentrations of 3 inflammatory cytokines than short time CPB group,and the difference was significant(p<0.05).The IL-6 concentration in CS group was significantly higher than C0 group at 6h,24 h and 48 h after turning off the machine,and the increase was even more significant when CPB time was over 120 min.CS group and C0 group showed no significant difference in IL-10 at cardiopulmonary bypass and turning off the machine(p>0.05).TNF-? concentrations were compared in both long CPB subgroup at 6h after turning off the machine;CS subgroup was significantly lower than C0 subgroup,and the difference was significant(p<0.05).Conclusion In cardiopulmonary bypass cardiac surgery procedures,cell saver effectively reduced the systemic levels of certain proinflammatory markers,the longer the CPB time the more obvious.Meanwhile it would not have negative impact on the postoperative bleeding and coagulation.