非心脏手术患者围术期大量输血后发生急性肺损伤/急性呼吸窘迫综合征的危险因素及预后分析  

The risk factors and prognostic analysis of acute lung injury /acute respiratory distress syndrome after massive perioperative blood transfusion in non-cardiac operation patients

作　　者：孙建萍[1] 仲维佳[1] 卢家凯[2] 张京岚[1] 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所综合外科ICU,北京100029 [2]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所麻醉科,北京100029

出　　处：《心肺血管病杂志》2014年第1期76-80,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:分析非心脏手术患者围手术期大量输血后发生急性肺损伤(acute lung injury,ALI)/急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的相关危险因素,并总结其预后的影响。方法:回顾2008年1月至2012年12月,非心脏手术后入SICU治疗,符合围手术期输血总量≥1 500mL的患者102例,其中术后发生ALI/ARDS的患者34例(A组),未发生ALI/ARDS的患者68例(B组),对比两组患者的性别、年龄、心功能、手术时间、术中出血量、围手术期输血液制品的总量、输液量、术后并发症及病死率等指标,总结A组患者术后氧合指数(PaO2/FiO2)的变化趋势,寻找影响ALI/ARDS发生的危险因素。结果:A组较B组患者手术时间长、输血总量及输液量多(P<0.05)。A组患者术后氧和指数在术后第2天达到最低(P<0.05)。A组患者气管插管时间、SICU停留时间较B组延长,术后二次气管插管、肾衰竭、多脏器功能不全综合征(multiple organ dysfunction syndrome,MODS)等并发症的发生多于B组(P<0.05),A组患者病死率较B组高(P<0.05)。Logistic回归分析显示,手术时间及术中输液量是影响ARDS发生的危险因子。结论:非心脏手术患者围手术期大量输血后发生ALI/ARDS的原因与患者手术时间、输血总量及输液量有关,发生ALI/ARDS的患者预后差。缩短手术时间、减少输血及输液量对改善手术患者的预后有一定作用。对于有发生ALI/ARDS倾向的患者,术后积极治疗是关键。Objective：To analyze the correlative risk factors of acute lung injury（ALI） /acute respiratory disorders syndrome （ARDS） in non-cardiac operation patients who received massive perioperative blood transfusion,and summarize the effect to prognoses.Methods：Review the non-cardiac surgery patients in SICU from Jan.2008 to Dec.2012,there were 102 patients that total performed blood transfusion over 1500mL during perioperative period.34 cases,as group A,had progressed to ALI/ARDS,and the other 68 cases,as group B,without ALI/ARDS.Compare the gender,age,heart function,operative time,amount of intraoperative bleeding,total amount of perioperative blood products transfusion,total amount of infusion,post-operative complications,and mortality,etc.,and summarize the variation tendency of oxygenation index（PaO2/FiO2） in post-operative patients from group A,discuss the independent risk factors inducing ALI/ARDS.Results：Factors as operative time,total amount of transfusion,and total amount of infusion of group A are all higher than group B （P ＜ 0.05）.The oxygenation index of patients from group A decrease to the lowest point on the second day after surgery（P ＜ 0.05）.Comparing with Group B,patients in Group A have longer intubation time and SICU duration,and more complications like reintubation,renal failure,multiple organ dysfunction syndrome（P ＜ 0.05）.Beside these,group A has higher mortality（P ＜ 0.05）,with bad prognoses.The results of logistic regression analysis shows that operative time and intraoperative infusion volume are independent risk factors inducing ARDS.Conclusion：The correlative reasons of ALI/ARDS related to massive blood transfusion during perioperative period of non-cardiac surgery are operative time,total amount of perioperative blood products transfusion and total amount of infusion.Patients with ALI/ARDS have bad prognoses.Shortening operative time,decreasing the amount of blood transfusion and infusion are also considered to improve prognoses.To the ALI/ARDS tende

关 键 词：急性肺损伤 急性呼吸窘迫综合征 围手术期 输血 

分 类 号：R56[医药卫生—呼吸系统]