심장 수술 환자에서 혈색소치 기준에 따른 적혈구 수혈 시 임상 양상 비교 = Comparison of the Clinical Outcomes of Red Blood Cell Transfusion in Cardiac Surgical Patients according to the Hematocrit

다국어 초록 (Multilingual Abstract)

Background: Recent studies have shown that blood transfusions, and especially red blood cells, are associated with potential adverse outcomes. This study was designed to investigate the effects of red blood cell transfusion according to the hematocrit on the clinical outcomes after cardiac surgery.
Methods: The 433 patients who were undergoing cardiac surgery were randomized to two groups. One group was transfused red blood cells with a hematocrit of 20%, and the other group was transfused red blood cells with a hematocrit of 20∼25%. The amounts of intraoperative and postoperative transfusion and various parameters of the clinical outcomes were checked.
Results: In the hematocrit ＜20% group, the amount of infused crystalloid during operation was larger than that of the hematocrit ＞20% group, and the postoperative hemoglobin and hematocrit were lower than that of the hematocrit ＞20% group. But there were no differences of the amounts of intraoperative and postoperative transfusion, the use of inotropics, the platelet count, the prothrombin time (PT), the activated partial thromboplastin time (aPTT), the levels of aspartate aminotransferase (AST), the levels of alanine aminotransferase (ALT), blood urea nitrogen (BUN), serum creatinine (Cr), brain natriuretic peptide (BNP) and creatine kinase MB (CK-MB), the extubation time and the ICU stay time between the two groups.
Conclusion: A hematocrit lower than 20% was tolerated by the cardiac surgical patients and it was not related to the postoperative morbidity and outcomes.

국문 초록 (Abstract)

배경: 최근 수혈로 인한 치명적 합병증들에 대한 보고로 수혈의 위험성이 강조되어 수혈기준에대한 재검토가 이루어지고 있다. 본 연구의 목적은 심장 수술 받는 환자에서 수혈을 시작하는 시점의 적혈구 용적률(hematocrit, Hct)에 따른 수혈양상과 임상 결과를 비교하는 데 있다.
방법: 심장 수술을 받는 433명의 환자를 대상으로 수혈은 시작하는 시점의 Hct를 기준으로 Hct 이 20% 이하에서 수혈하는 군과 Hct이 20∼25%이상으로 유지되도록 수혈하는 군으로 나누어 연구를 진행하였다. 두 군 간에 수술 중, 수술 후 수혈 양상 및 수액 투여량을 비교하였고, 수술 후혈색소치(hemoglobin, Hb), Hct, Aspartate aminotransferase (AST), Alanine aminotransferase (ALT),Blood urea nitrogen (BUN), serum creatinine (Cr),brain natriuretic peptide (BNP), Creatine Kinase MB (CK-MB) 검사를 시행하여 비교하였다. 그리고승압제 사용량, 발관까지 걸린 시간과 중환자실체류시간을 함께 비교하였다.
결과: Hct ＜20% 군에서 수술 중 결정질용액의투여량이 통계적으로 유의하게 많았고, 수술 후Hb, Hct가 유의하게 낮았으나 수술 후 수혈량, 승압제 사용량, AST, ALT, BUN, Cr, BNP, CK-MB 수술 후 발관까지 걸린 시간 및 중환자실 체류시간은 두 군 간의 차이가 없었다.
결론: 심장 수술 환자에서 농축 적혈구 수혈기준을 Hct 20% 이하로 하였을 때, 수술 중 결정질용액의 투여량은 증가하였지만 심각한 합병증이나 문제는 발생하지 않았다.

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