改良节约用血策略后先天性心脏病患儿输血影响因素分析  

Risk factors of transfusion in infants undergoing cardiac surgery with bloodsparing strategy

作　　者：邹丽华[1] 刘晋萍[1] 冯正义[1] 赵举[1] 崔勇丽[1] 赵明霞[1] 李守军[2] 闫军[2] 晏馥霞[3] 王旭[2] 

机构地区：[1]北京协和医学院,中国医学科学院,阜外心血管病医院体外循环科,北京100037 [2]北京协和医学院,中国医学科学院,阜外心血管病医院小儿心脏外科,北京100037 [3]北京协和医学院,中国医学科学院,阜外心血管病医院麻醉科,北京100037

出　　处：《中国体外循环杂志》2015年第3期146-149,160,共5页Chinese Journal of Extracorporeal Circulation

基　　金："首都临床特色应用研究"专项(Z131107002213172);协和医学院研究生创新基金(2013-1002-29)

摘　　要：目的探索改良节约用血策略下体重≤15 kg先天性心脏病患儿围术期输血的影响因素。方法 283例患儿先后实施改良节约用血策略即无血预充方案的先天性心脏病手术,若患儿在体外循环期间发生与低血红蛋白浓度相关的缺氧指征时,则需严格按照输血指征申请输血治疗,并纳入术中输血组;手术后进行输血治疗的患儿则纳入到术后输血组;成功实施免输血手术的患儿,需纳入免输血组,收集三组患儿围术期的血气指标及血制品的用量,记录术后24 h胸液引流量及患儿术后早期恢复的相关指标。结果多因素logistic回归分析表明,术前较高红细胞比容(Hct)、体重、身高水平与降低术中输血风险相关[OR=0.811,CI(0.729-0.901),P<0.001;OR=0.717,CI(0.598-0.859),P<0.001;OR=0.909,CI(0.846-0.975),P=0.008],增加预充量则增加术中输血风险[OR=1.006,CI(1.001-1.012),P=0.032],体重、紫绀分别为术后输血的保护因素与危险因素[OR=0.833,CI(0.730-0.955),P=0.009;OR=2.597,CI(1.168-5.774),P=0.019]。结论应用改良节约用血策略基础上,15 kg以下患儿围术期输血受到术前Hct、体重、身高、预充量、紫绀的影响。Objective To evaluate the risk factors of transfusion in infants（≤15 kg）who had cardiac surgerywithapplication of amodified blood-sparing technique.Methods 283 infants were included with a new blood-sparing method,known as non-homologous blood priming technique.Infants were classified into three groups：intraoperative transfusion group（IT group） that requiredtransfusion during operation,postoperative transfusion group（PT group） and transfusion-free group（TF group）.All infants underwent routine heart surgery with cardiopulmonary bypass.Clinic data and transfusion requirements were collected during operation,at ICU,and in ward.Results Multivariate logistic regression showed that lower preoperative hematocrit,lower body weight and smaller body size could reduce the risk of intra-operative transfusion[OR = 0.811,CI（0.729-0.901）,P〈0.001;OR = 0.717,CI（0.598-0.859）,P〈0.001;OR = 0.909,CI（0.846-0.975）,P = 0.008].Priming volume was associated with the increased risk of transfusion[OR = 1.006,CI（1.001-1.012）,P =0.032].Similarly,body weight could reduce the risk of post-operative transfusion.However,preoperative cyanosis was associated with increased risk of post-operative transfusion[OR = 0.833,CI（0.730-0.955）,P =0.009;OR = 2.597,CI（1.168-5.774）,P =0.019].Conclusion Our research identified the risk and protective factors of blood sparingin infant with body weight less than 15 kg for cardiac surgery.

关 键 词：体外循环 婴幼儿 节约用血 

分 类 号：R726.5[医药卫生—儿科]