胸内消化道肿瘤患者围术期高需求输血相关因素分析及评价  

Analysis and evaluation of correlative factors of high perioperative blood transfusion demand for patients with intrathoracic digestive tract tumor

作　　者：曾庆鹏 李嘉根 薛奇 黄进丰 张良泽 高树庚 赵峻 ZENG Qingpeng;LI fiagen;XUE Qi;HUANG Jinfeng;ZHANG Liangze;GAO Shu- geng;ZHAO Jun.(Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sci- ences ＆ Peking Union Medical College, Beijing 100021, China.)

机构地区：[1]国家癌症中心中国医学科学院北京协和医学院肿瘤医院胸外科

出　　处：《中国输血杂志》2018年第3期247-251,共5页Chinese Journal of Blood Transfusion

摘　　要：目的了解食管癌与贲门癌患者围术期高需求输血的原因,分析高需求输血对术后恢复及相关生化指标变化的影响。方法从2012年10月—2017年10月中国医学科学院肿瘤医院胸外科行食管癌与贲门癌手术患者的病历资料中,收集围术期输注红细胞≥5 U的病例27例（高需求输血组）,从输注红细胞〈5 U的手术患者中筛选27例（对照组）,对比2组患者临床特征,分析高需求输血的原因及影响因素及其对患者术后恢复的影响,包括术后并发症发生率、住院时间及住ICU时间、输血前后血小板计数（Plt）,凝血指标,K＋、Ca2＋水平的变化等;以DC检测法测定Plt,凝血项目中PT、APFT、TT指标应用凝固法测定,K＋、Ca2＋指标以离子选择电极间接法测定。结果 2012年10月—2017年10月本院胸外科食管癌及贲门癌围术期高需求输血率为0.42%（27/6 448）,其中1）高需求输血组与对照组比较,术前存在合并症患者比例为66.67%（18/27）vs 37.04%（10/27）（P〈0.05）,存在贫血患者比例为48.15%（13/27）vs 22.22%（6/27）（P〈0.05）;2）患者术后延迟性出血所致与术中出血所致的高需求输血比例为62.96%（17/27）vs 33.33%（9/27）（P〈0.05）;3）高需求输血组与对照组患者并发症发生率为62.96%（17/27）vs 33.33%（9/27）（P〈0.05）,住院时间（d）及住ICU时间（d）分别为（24.70±17.60）vs（21.41±8.16）、（1.12±2.01）vs（0.37±1.36）（P〉0.05）;4）高需求输血组输血前后Plt（×1012/L）,K＋、Ca2＋水平（mmol/L）分别为235.59±76.44 vs 159.81±87.80（P〈0.05）,4.18±0.39 vs 3.94±0.47、2.35±0.43 vs 1.90±0.29（P〈0.05）,对照组相应为225.89±62.47 vs190.59±61.15（P〈0.05）,4.21±0.36 vs 4.17±0.43（P〉0.05）、2.28±0.19 vs 2.02±0.14（P〈0.05）。结论术前存在合并症与贫血是影响食管癌及贲门癌患者围术期高需求输血的危险因素,高需求输血主要因术后出血导致,且会Objective To understand the causes of high perioperative blood transfusion demand in patients with esophageal and cardiac cancer,and to analyze the influence of high blood transfusion demand on postoperative recovery and the changes of related biochemical indexes. Methods Esophageal and cardiac cancer Patients ＇ clinical data（ Oct,2012-Oct,2017） was collected in the Department of Thoracic Surgery,Cancer Hospital,Chinese Academy of Medical Sciences were collected. A total of 27 cases with red blood cell（ RBC） transfusion volumes ≥5 U were defined as the high transfusion demand group. Another 27 cases were selected from the rest of the patients as the control group. By comparing the clinical characteristics between two groups,the influencing factors of high blood transfusion demand and the influence of high transfusion demand on postoperative recovery were analyzed.Results A total of 6448 patients with esophageal and cardiac cancer underwent surgery in our department from October 2012 to October2017 and the high blood transfusion demand rate was 0. 42%（ 27/6 448）.（ 1） The ratio of patients with preoperative comorbidities was 66. 67%（ 18/27） in the high demand transfusion group versus 37. 04%（ 10/27） in the control group（ P〈0. 05）,and the ratio of patients with anemia was 48. 15%（ 13/27）versus 22. 22%（ 6/27）（ P〈0. 05）.（ 2） The ratio of high blood transfusion demand caused by postoperative delayed bleeding and intraoperative bleeding was 62. 96%（ 17/27） vs 33. 33%（ 9/27）（ P〈0. 05）,respectively.（ 3） The incidence of complications was 62. 96%（ 17/27） in the high transfusion demand group versus 33. 33%（ 9/27） in the control group（ P〈0. 05）,and the length of hospitalization（ d） and ICU stay（ d） were（ 24. 70 ± 17. 60） vs（ 21. 41 ± 8. 16）（ P〈0. 05）,（ 1. 12±2. 01） vs（ 0. 37±1. 36）（ P〈0. 05）,respectively.（ 4） The platelet count（ Plt）,K＋and Ca2＋levels（ mmol/L） of pre-and post-transfusion

关 键 词：食管癌 贲门癌 胸内消化道肿瘤 高需求输血 围术期 术前合并症 贫血 

分 类 号：R457.1[医药卫生—治疗学] R735[医药卫生—临床医学]