围术期输血与冠状动脉旁路移植术后近远期临床结果的相关性  

Influence of Perioperative Blood Transfusion on Short- term,Long- term Outcomes after Coronary Artery Bypass Grafting

作　　者：吴慧[1] 胡盛寿[1] 郑哲[2] 纪宏文[2] 陈祖君[2] 袁昕[2] 侯剑峰[2] 

机构地区：[1]中国医学科学院北京协和医学院 阜外心血管病医院 心血管病研究所 成人外科中心ICU,北京市100037 [2]中国医学科学院北京协和医学院 阜外心血管病医院心 血管病研究所 成人外科中心ICU,北京市100037

出　　处：《中国全科医学》2013年第30期3554-3558,共5页Chinese General Practice

摘　　要：目的分析单纯冠状动脉旁路移植术(CABG)患者围术期输血对术后近、远期临床结果的影响。方法回顾性分析我院2006—2008年行单纯CABG的4 022例患者,依据患者围术期红细胞的使用量分为3组:红细胞未使用(组Ⅰ,1 884例)、红细胞使用≤4 U(组Ⅱ,1 355例)、红细胞使用>4 U(组Ⅲ,783例)。采用单因素和多元Logistic回归分析围术期输血与院内临床结果的相关性;采用单因素和多因素Cox回归分析围术期输血与远期终点事件的相关性。结果 3组患者院内死亡、围术期心肌梗死、二次手术、心搏骤停或心室纤颤、卒中、主要事件、次要事件发生率比较,差异均有统计学意义(P<0.05)。围术期输血与院内主要事件、次要事件的关系有统计学意义(P<0.05);其中组Ⅱ患者较组Ⅰ患者主要事件(2.65倍)发生的风险增加,组Ⅲ患者较组Ⅰ患者主要事件(38.18倍)、次要事件(1.46倍)发生的风险增加。3组患者远期随访全因死亡、心源性死亡发生率比较,差异均有统计学意义(P<0.05)。Cox回归分析结果显示,围术期输血与全因死亡、心源性死亡间有关联(P<0.05);其中组Ⅲ患者较组Ⅰ患者全因死亡(2.52倍)、心源性死亡(3.64倍)的风险增加。结论围术期输血显著增加了CABG患者院内并发症、主要事件、次要事件及远期全因死亡、心源性死亡发生的风险,使用量>4 U的患者风险更高。因此,建议尽可能减少不必要输血。Objective To analyze the influence of perioperative blood transfusion on short - term and long - term outcomes after coronary artery bypass grafting （CABG） . Methods 4 022 consecutive patients undergoing isolated coronary artery bypass grafting from January 2006 to December 2008 were analyzed retrospectively. The patients were divided into three groups by the usage amount of red blood ceils （RBCs） ： not use （ group I , n = 1 884）, usage of RBCs ~〈4 U （ group II, n = 1 355） and usage of RBCs 〉4 U （group m, n = 783） . Univariate and multivariate Logistic regression analysis were performed to investigate the correlation between in - hospital outcomes and perioperative blood transfusion; Univariate, and multivariate Cox analysis were used to examine the correlation between perioperative blood transfusion and long - term prognosis. Results There were significant differences among three groups in in - hospital mortallty, perioperative myocardial infarction, secondary surgery, cardiac arrest or ventricular fibrillation, stroke, major and secondary events （P 〈 0. 05 ） . Perioperative blood transfusion was significantly related with the whole incidence of major events and secondary events （P 〈 0.05） ： group II had greater relative risk than group I in major events by 2. 65 times, while group Ill had greater relative risk than group I in major events by 38. 18 times and secondary events by 1.46 times. There were significant differences among three groups in long - term all - cause deaths and cardiac deaths （ P 〈 0. 05 ） . Cox analysis revealed that perioperative blood transfusion was significantly related with all - cause deaths and cardiac deaths （P 〈 0. 05） ： group HI had greater relative risk than group I in all - cause deaths by 2. 52 times and cardiac deaths by 3.64 times. Conclusion Perioperative blood transfusion significantly increases the rates of in - hospital major events,secondary events, and long - term all - cause deaths, cardiac deaths of CABG patients, a

关 键 词：冠状动脉旁路移植术 非体外循环 输血 手术期间 

分 类 号：R654.2[医药卫生—外科学]