Application Of Intraoperative Blood Salvage In Elderly Patients With Off-pump Coronary Artery Bypass Grafting

Objective Retrospective analysis of the effect of intraoperative blood salvage(IBS)for the use of off-pump coronary artery bypass grafting in elderly patients.Method Retrospective analysis was performed on 167 elderly patients who underwent OPCABG surgery in December 2012 to December 2016.There were 84 males and 83 females,aged 65-82 years,weight 46-94 kg,ASA physical status Ⅲ-Ⅳ,cardiac function Ⅲ-Ⅳ.According to apply IBS or not,patients were divided into intraoperative blood salvage group(IBS group,n=76)and control group(AB group,n=91).Observation indicators included the volume of intraoperative bleeding(ml),HGB、WBC、PLT、RBC numbers at the day before and 1,2 and 7 days after operation,PT、APTT at the day before and 1 day and 7 days after operation,the volume of autologous blood transfusion(ml),the amount of allogeneic RBC(u)and plasmat transfusion(ml),the volume of mediastina tube drainage 24 h after surgery(ml)and long time of operation(min),long time of mechanical ventilation(h),long stay of ICU(h),long time of hospitalization(d),and complications related to perioperative period,etc.Results There was no significant difference between the two groups in IABP utilization rate,the number of bypass grafts,the amount of intraoperative bleeding,the duration of hospitalization,the time of mechanical ventilation and the time of operation(P > 0.05).The blood transfusion of the two groups showed that there was no significant difference in the blood transfusion between the two groups(P > 0.05).Compared with group AB,the total transfusion volume of plasma and the drainage flow at 24 hours after operation in IBS group were significantly lower than those in group AB,and the relative data of blood indexes were compared between the two groups.There was no significant difference between the two groups(P > 0.05).The white blood cell count in the two groups was significantly higher than that in the AB group on the 2nd day after operation(P > 0.05),but there was no significant difference in the number of white blood cells between the two groups on the 7th day after operation(P > 0.05).There was no significant difference between the two groups on the 1st day and the 2nd day after operation(P > 0.05).However,PTT APTT at 1 day after operation was significantly longer than that before operation.The perioperative transfusion related complications in group AB were significantly longer than those in group IBS,and the adverse reactions during perioperative period in group AB were lower than those in group AB(P < 0.05),and the difference was statistically significant.The incidence of delayed wound healing and pulmonary infection was slightly lower in group AB than in group AB,but there was no significant difference(P > 0.05).The cost of allogeneic blood transfusion in IBS group was significantly lower than that in AB group(P < 0.05),but there was no significant difference in total blood transfusion cost between the two groups.Conclusion IBS can significantly reduce the blood transfusion volume of allogeneic red blood cells and plasma,decrease the incidence of transfusion related adverse reactions,and have no significant effect on coagulation function in elderly patients undergoing coronary artery bypass grafting.However,it may lead to a transient increase in leukocyte after operation,so the combination of leukocyte filters should be taken into consideration.Compared with the simple transfusion of allogeneic blood,the application of IBS does not affect the postoperative outcome of the patients,and does not increase the total blood transfusion cost.It can be used safely and effectively in elderly patients with OPCABG.