翻译：钮阳 徐州医科大学2024级硕士研究生
审校：赵林林 徐医附院麻醉科
《Journal Of Cardiothoracic & Vascular Anesthesia》2024年10月第38卷第9期
《Journal Of Cardiothoracic & Vascular Anesthesia》2024年9月刊第38卷第9期
《Journal Of Cardiothoracic & Vascular Anesthesia》2024年8月刊第38卷第8期
《Journal Of Cardiothoracic & Vascular Anesthesia》2024年7月刊第37卷第7期
《Journal Of Cardiothoracic & Vascular Anesthesia》2024年6月刊第38卷第6期
《Journal Of Cardiothoracic & Vascular Anesthesia》2024年5月刊第38卷第5期
《Journal Of Cardiothoracic & Vascular Anesthesia》2024年4月刊第38卷第4期
《Journal Of Cardiothoracic & Vascular Anesthesia》2024年3月刊第38卷第3期
《Journal Of Cardiothoracic & Vascular Anesthesia》2024年2月刊第38卷第2期
《Journal Of Cardiothoracic & Vascular Anesthesia》2024年1月刊
《Journal Of Cardiothoracic & Vascular Anesthesia》2024年11月刊第38卷第11期
EDITORIALS
1.A Glass Half Full? Surgical Volume and Clinical Outcomes in Pediatric Congenital Heart Surgery
半杯水满吗？小儿先天性心脏病手术量与临床结果
2.Perioperative Implications of the 2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy
2024年AHA/ACC/AMSSM/HRS/PACES/SCMR肥厚型心肌病管理指南的围手术期影响
3.Outcomes in Early Atrial Fibrillation Diagnosis
早期心房颤动诊断的结果
SPECIAL ARTICLES
1.The Year in Cardiothoracic Transplant Anesthesia: Selected Highlights From 2022 Part I: Lung Transplantation
2022年度心胸移植麻醉回顾：精选亮点第一部分：肺移植
2.Quo Vadis, ECMO? Multidisciplinary Hybrid Extra Corporeal Membrane Oxygenation Rounds During the COVID-19 Pandemic
ECMO何去何从？COVID-19大流行期间的多学科杂交体外膜肺氧合查房
ORIGINAL ARTICLES
1.The Diagnostic Accuracy of EXTEM and HEPTEM Clotting Times Versus Standard Laboratory Tests in Cardiac Surgical Patients With and Without Normal FIBTEM Values
在fitem值正常和不正常的心脏手术患者中，EXTEM和HEPTEM凝血时间与标准实验室检查的诊断准确性
Objectives
There is extensive evidence to support the use of FIBTEM to identify hypofibrinogenemia during cardiac surgery, but less to support the use of EXTEM and INTEM clotting times (CTs) to identify other plasmatic coagulation factor deficiencies. The aim of the current study was to assess the diagnostic accuracy of EXTEM, INTEM, and HEPTEM CTs, using laboratory international normalized ratio (INR) and activated partial thromboplastin time (aPTT) as reference standards.
有广泛的证据支持在心脏手术中使用FIBTEM来识别低纤维蛋白原血症，但较少支持使用EXTEM和INTEM凝血时间（ct）来识别其他血浆凝血因子缺乏。本研究的目的是评估EXTEM， INTEM和HEPTEM ct的诊断准确性，使用实验室国际标准化比率（INR）和活化部分凝血活素时间（aPTT）作为参考标准。
Design
This was a retrospective diagnostic accuracy study
设计本研究为回顾性诊断准确性研究
Setting
The work took place at a tertiary referral hospital.
这项工作在一家三级转诊医院进行。
Participants
A total of 176 cardiac surgical patients were enrolled.
共有176名心脏手术患者被纳入研究。
Interventions
INR, aPTT, ROTEM EXTEM, INTEM, and HEPTEM were measured post–heparin reversal after cardiopulmonary bypass.
在体外循环术后肝素逆转后测量干预INR、aPTT、ROTEM、EXTEM、INTEM和HEPTEM。
Measurements and Main Results
Sensitivity, specificity, and positive (PPVs) and negative predictive values (NPVs) for EXTEM CT >80 seconds and HEPTEM CT >280 seconds to detect INR ≥2.0, and INTEM CT >205 seconds to detect aPTT ≥38.5 seconds were calculated for all patients and the subset with normal FIBTEM A5 (>6 mm). The prevalence of INR ≥2.0 was 13%. EXTEM CT >80 seconds had a sensitivity of 1.00, specificity of 0.25, PPV of 0.17, and NPV of 1.00. HEPTEM CT >280 seconds had a sensitivity of 0.91, specificity of 0.38, PPV of 0.18, and NPV of 0.97. INTEM CT >205 seconds had a sensitivity of 0.97, specificity of 0.11, PPV of 0.57, and NPV of 0.75 for aPTT ≥38.5 seconds. These values were similar for the subset of patients with normal FIBTEM A5.
计算所有患者和fitem A5 （>6 mm）正常亚组的EXTEM CT >80秒、HEPTEM CT >280秒检测INR≥2.0、INTEM CT >205秒检测aPTT≥38.5秒时的敏感性、特异性、阳性预测值（ppv）和阴性预测值（npv）。INR≥2.0的患病率为13%。EXTEM CT >80秒的敏感性为1.00，特异性为0.25，PPV为0.17，NPV为1.00。HEPTEM CT >280秒的敏感性为0.91，特异性为0.38，PPV为0.18，NPV为0.97。当aPTT≥38.5秒时，interm CT >205秒的敏感性为0.97，特异性为0.11，PPV为0.57，NPV为0.75。这些值与fitem A5正常患者亚组相似。
Conclusions
EXTEM CT >80 seconds and HEPTEM CT >280 seconds have high sensitivities and NPVs for INR >2.0, which would effectively “rule out” INR >2.0 as a cause for excessive bleeding.
However, the low specificities and PPVs indicate they would be less effective in ruling it in.
INTEM CT >205 seconds had low PPV and NPV in identifying aPTT >38.5 seconds.
结论EXTEM CT >80秒、HEPTEM CT >280秒对INR >2.0有较高的敏感性和npv值，可有效“排除”INR >2.0导致大出血的可能。然而，低特异性和ppv表明它们在治理中效果较差。
interm CT >205秒，识别aPTT >38.5秒的PPV和NPV较低。
2.Comparison of the Quantra QPlus and ROTEM Goal-Directed Transfusion Protocols in Cardiothoracic Surgery Patients: A Prospective Observational Study
2.Quantra QPlus和ROTEM目标导向输血方案在心胸外科患者中的比较：一项前瞻性观察研究
Objectives
To compare the designed treatment protocols for the Quantra QPlus and rotational thromboelastometry (ROTEM) with regard to transfusion advice.
目的比较Quantra QPlus和旋转血栓弹性测量（ROTEM）设计的治疗方案在输血建议方面的差异。
Design
Prospective observational study
前瞻性观察研究
Setting
Maastricht University Medical Center, The Netherlands.
设置荷兰马斯特里赫特大学医学中心。
Participants
Adults with elective cardiopulmonary bypass surgery with a ROTEM test.
受试者为接受选择性体外循环手术的成人，采用ROTEM测试。
Interventions
ROTEM tests were performed postoperatively for standard monitoring of coagulation status and clinical decision making. Simultaneously, a concurrent sample was analyzed for the Quantra QPlus.
干预措施术后进行ROTEM测试，用于标准监测凝血状态和临床决策。同时，对Quantra QPlus的并发样本进行了分析。
Measurements and Main Results
A total of 100 samples were analyzed using both the ROTEM and Quantra QPlus. Agreement between the transfusion advice for the ROTEM and Quantra QPlus protocols were compared using Cohen κ values for i.a. fibrinogen, platelet concentrates, and fresh frozen plasma (FFP).The agreement between ROTEM and Quantra QPlus was poor for overall transfusion (0.174) and fibrinogen transfusion (0.300). The agreement of cutoff values for fibrinogen clot stiffness for the Quantra QPlus and EXTEM A10 for the ROTEM was poor (0.160). The fibrinogen clot stiffness and FIBTEM A10 had a moderate agreement (0.731). A Cohen κ could not be calculated for the agreement of protamine, thrombocytes, FFP or cutoff values for these transfusions since frequencies included zero in these cases. The Quantra QPlus transfusion protocol advises transfusion in many non-bleeders, adjustments appear to be necessary. In a small group of cases in which clinically relevant blood loss was observed, the Quantra QPlus advised administration of transfusion products, whereas the ROTEM tests did not.
使用ROTEM和Quantra QPlus对总共100个样品进行了分析。采用纤维蛋白原、血小板浓缩物和新鲜冷冻血浆（FFP）的Cohen κ值比较ROTEM和Quantra QPlus方案输血建议的一致性。在总输注（0.174）和纤维蛋白原输注（0.300）方面，ROTEM和Quantra QPlus的一致性较差。Quantra QPlus的纤维蛋白原凝块硬度临界值与EXTEM A10的ROTEM临界值的一致性很差（0.160）。纤维蛋白原凝块硬度和fitem A10有中等一致性（0.731）。由于这些病例的频率为零，因此无法计算出这些输血的鱼精蛋白、血小板、FFP或截止值的一致性。Quantra QPlus输血方案建议在许多非出血患者中输血，调整似乎是必要的。在一小组观察到临床相关失血的病例中，Quantra QPlus建议输液产品的管理，而ROTEM测试则没有。
Conclusion
ROTEM-guided and Quantra-guided transfusion did not correspond in this patient group, and agreement was moderate at best. Specificity and sensitivity for transfusion within protocols were heterogeneous between the methods. More clinical research in high-bleeding risk populations is needed to determine the clinical impact of the different protocols.
结论 在本组患者中，rotem引导与quantra引导输血不一致，一致性最好为中等。方案内输血的特异性和敏感性在不同的方法之间存在差异。需要对高出血风险人群进行更多的临床研究，以确定不同方案的临床影响。
CASE REPORTS
1.Walking the Tightrope: Anticoagulation Management of Patients with Antiphospholipid Syndrome and Immune Thrombocytopenic Purpura Undergoing Mitral Valve Replacement With Cardiopulmonary Bypass
如履薄冰：接受心肺转流下二尖瓣置换术的抗磷脂综合征和免疫性血小板减少性紫癜患者的抗凝管理
2.Severe heparin resistance during repeat aortic valve repair unresponsive to plasma and antithrombin III
重复主动脉瓣修复术中出现严重肝素抵抗，对血浆和抗凝血酶III无反应
3.Cardiac Arrest in a Patient Unveils Pheochromocytoma With Rare Clinical Manifestation Requiring Extracorporeal Membrane Oxygenation and Urgent Surgery
患者心脏骤停揭示罕见临床表现的嗜铬细胞瘤，需体外膜肺氧合和紧急手术
4.Transcatheter Tricuspid Valve Replacement With the Novel LuX-Valve Plus: Case Descriptions and Anesthetic Considerations
使用新型LuX-Valve Plus进行经导管三尖瓣置换术：病例描述和麻醉考虑
REVIEW ARTICLES
1.Anesthetic Techniques for Ablation in Atrial Fibrillation: A Comparative Review
心房颤动消融术的麻醉技术：一项对比综述
2.Hypoattenuated Leaflet Thickening: A Comprehensive Review of Contemporary Data
中文：瓣膜小叶低衰减增厚：当代数据的全面综述
3.The Fontan Circulation in Pregnancy: Hemodynamic Challenges and Anesthetic Considerations
妊娠期的Fontan循环：血流动力学挑战与麻醉考虑
4.The Effects of Corticosteroids on Survival in Pediatric and Nonelderly Adult Patients Undergoing Cardiac Surgery: A Meta-analysis of Randomized Studies
皮质类固醇对接受心脏手术的儿童和非老年成年患者生存率的影响：一项随机研究的荟萃分析
EXPERT REVIEWS
1.Air Quality and Cardiovascular Mortality: Analysis of Recent Data
空气质量与心血管死亡率：最新数据分析
2.Alph
a-Gal Syndrome and Cardiac Surgery
Alpha-Gal综合征与心脏手术
CASE CONFERENCE
1.Diffuse Coronary Artery Vasospasm Following Aortic Valve Replacement in a Patient With Scleroderma
硬皮病患者主动脉瓣置换术后弥漫性冠状动脉痉挛
2.Commentary: Scleroderma and Coronary Vasospasm After Cardiac Surgery: A Serious Combination
评论：心脏手术后的硬皮病与冠状动脉痉挛：一种严重的组合
3.Commentary: Diffuse Coronary Artery Vasospasm Following Aortic Valve Replacement in a Patient With Scleroderma
评论：硬皮病患者主动脉瓣置换术后弥漫性冠状动脉痉挛
PRO & CON
1.Pro: Is Minimally Invasive Extracorporeal Circulation Superior to Conventional Cardiopulmonary Bypass in Cardiac Surgery?
正方观点：在心脏手术中，微创体外循环是否优于传统心肺转流术？
2.Con: Is Minimal Invasive Extracorporeal Circulation Superior to Conventional Cardiopulmonary Bypass in Cardiac Surgery?
反方观点：在心脏手术中，微创体外循环是否并不优于传统心肺转流术？
DIAGNOSTIC DILEMMAS
1.Unraveling a Cause for Right Ventricular Dilation
揭示右心室扩张的原因
2.False Aortic Dissection in a Patient on Extracorporeal Membrane Oxygenation Support
体外膜肺氧合支持患者中的假性主动脉夹层
