腰椎管狭窄减压术与围手术期输血相关性的研究  

Research on decompression of lumbar spinal stenosis and perioperative blood transfusion

作　　者：毕晓琳[1] 李宁[1] 范亚欣[1] 王忠利[2] 李玉忠[2] 马晓露[3] 高艳[4] 曲健[5] 

机构地区：[1]大连市血液中心,辽宁大连116001 [2]大连医科大学附属第二医院 [3]大连医科大学附属第一医院 [4]大连市中心医院 [5]大连医科大学

出　　处：《中国输血杂志》2016年第9期941-944,共4页Chinese Journal of Blood Transfusion

摘　　要：目的探讨腰椎管狭窄减压术围手术期输血的影响因素,明确输血种类和输血量的范围,制定科学的干预措施,为建立腰椎管狭窄减压术围手术期输血的评价模式提供依据。方法选取大连地区3家三级甲等医院接受腰椎管狭窄减压术患者386例,根据是否输注异体血分为输血组(139例)和未输血组(247例);根据患者的输血量将输血组分为≤4U组和>4U组;根据输血方式分为异体输血组,自体输血组和(自体+异体)输血组。收集386例腰椎管狭窄减压术患者的基本信息(性别、年龄、临床诊断)、手术相关信息(手术时间、术中失血量)、血常规(包括术前、术中、术后)、凝血功能指标(包括术前、术中、术后)、患者转归情况(抗生素使用情况、住院天数、切口愈合情况)以及围术期输血种类和输血量,并进行统计学分析。结果腰椎管狭窄减压术患者围手术期输血比例为36.01%,患者平均用血量(4.9±2.95)U。输血组和未输血组在年龄、手术时间、术中失血量、术前Hb、住院天数方面具有显著性差异,P<0.05。输血组中≤4 U组和>4 U组在手术时间和术中失血量方面具有显著性差异,P<0.05。异体输血组和自体输血组在抗生素使用种类方面有显著性差异,P<0.05;异体输血组、(自体+异体)输血组、自体输血组在其他转归情况上无显著性差异,P>0.05。患者术中输血量与术中失血量、手术时间和术前血红蛋白浓度的相关系数分别为0.001、0.176、-0.163,呈相关性(P<0.05)。结论对腰椎管狭窄减压术围手术期输血的影响因素有术中失血量、手术时间和术前患者Hb,自体输血组、异体输血组和(自体+异体)输血组在对患者术后转归方面基本上无统计学意义。Objectives To explore factors affecting blood transfusion associated with the decompression of lumbar spinal stenosis and to define the range of transfusion volume according to blood products in order to develop scientific interventions and to provide evidence for establishing an assessment mode for blood transfusion related with decompression of lumbar spinal stenosis. Methods 386 cases of the decompression of lumbar spinal stenosis selected in three hospitals in Dalian were divided into two groups： 139 cases for transfusion and 247 for nqntransfusion. The transfusion group was further divided into subgroups according to two factors, respectively： transfusion volume： ≤4 U and 〉4 U, and manner of transfusion： allogeneic transfusion, autologous transfusion and hybrid transfusion. Detail information was collected and analyzed, including essential information （age, gender, diagnosis）, operation information （time of operation, bleeding volume during operation）, blood routine tests and coagulation tests before, during and after operation, postoperative recovery （antibiotics treatment, days of hospitalization, wound healing） and traiasfusion products and volume. Results 36. 01% of patients with decompression of lumbar spinal stenosis received blood transfusion, with the average volume of （ 4. 9 ± 2. 95 ） U. There were significant differences in age, time of operation, bleeding volume, hemoglobin level（Hb） of pre-operation and days of hospitalization between transfusion and nontransfusion group （P 〈 0. 05 ）. Obvious differences were observed in times of operation and bleeding volume between two transfusion volume subgroups （ P 〈 0. 05 ）. There was no difference in postoperative recovery among 3 subgroups of transfusion manner （ P 〉 0.05 ）, except for the aspect of the kinds of antibiotics between allogeneic and autologous transfusion （ P 〈 0. 05 ）. Transfusion volume was well correlated with bleeding volume during operation （ r = 0. 001 ）, time of operation �

关 键 词：腰椎管狭窄减压术 围手术期输血 影响因素 

分 类 号：R457.1[医药卫生—治疗学] R687.3[医药卫生—临床医学]