术中自体回输颅脑占位手术患者围术期用血分析  

Perioperative blood transfusion analysis of cranicerebral operations on the basis of introperative

作　　者：魏超 关迺喆[1] 汪德清 WEI Chao;GUAN Naizhe;WANG Deqing(Department of Blood Transfusion,Beijing Electrical Hospital Affiliated to Capital Medical University,Beijing 100073;Department of Blood Transfusion,Chinese PLA General Hospital,Beijing 100853)

机构地区：[1]首都医科大学电力教学医院输血科,北京100073 [2]中国人民解放军总医院输血科,北京100853

出　　处：《国际检验医学杂志》2017年第A02期79-82,共4页International Journal of Laboratory Medicine

摘　　要：目的分析颅脑占位手术患者围术期出血及用血的影响因素,为此类患者临床用血管理提供理论依据。方法收集170例颅脑占位手术患者信息,分析其围术期自体血及异体血用血使用情况,同时根据术中出血量将患者分为出血量<800mL组和出血量≥800mL组,比较两组间患者术前基本情况,围术期用血情况以及术后转归。结果我们发现所有170例颅脑占位患者中,输自体血和异体血的比例分别为90.6%和10%。比较出血量<800mL组和出血量≥800mL组患者情况,出血≥800mL组中糖尿病患者比例增高(7%vs.0.8%,P=0.052);术前PT时间缩短(10.7vs.10.9,P=0.037);手术时间更长(283minvs.191min,P<0.001);自体输血量更多(466mLvs.145mL,P<0.001);且有更高的异体血输血率(32.6%vs.2.4%,P<0.001),输注了更多的异体红细胞(0.93Uvs.0.06U,P=0.005)和血浆(169.77mLvs.4.72mL,P=0.001);同时,出血≥800mL组患者术后PLT计数减少(180.9vs.216.5,P=0.002);术后血肌酐显著增高(71.2vs.65.2,P=0.022)。结论术中自体血液回输为颅脑占位手术患者节约了大量血液资源,糖尿病史,手术时间延长等可能是术中出血量的影响因素,此外,术中大量出血可能导致术后血小板计数减少和血肌酐水平的增高,影响患者预后。Objective Analyze the influence factors of perioperative blood loss and blood use of craniocerebral operation patients,and provide theoretical basis for clinical blood management.Methods We collected170craniocerebral operation patients,and analyzed their autologous and allogeneic blood use during perioperative period.At the same time,we divided the patients into<800mL group and≥800mL group according to the intraoperative blood loss,and variables of the basic situation,perioperative blood use and postoperative outcome were compared between the two groups.Results We found the proportion of autologous and allogeneic blood transfusion was90.6%and10%in all the170cases of craniocerebral operation patients.Compared with the<800mL group,the≥800mL group have more diabetics(7%vs.0.8%,P=0.052).Meanwhile,there were shoter PT time(10.7vs.10.9,P=0.037),longer operation time(283min vs.191min,P<0.001),more autologous blood transfusion cases(32.6%vs.2.4%,P<0.001),more allogeneic RBC(0.93U vs.0.06U,P=0.005)and plasma(169.77mL vs.4.72mL,P=0.001)use in the≥800mL group.Compared the variables of postoperative outcomes,we found the PLT count decreased(180.9vs.216.5,P=0.002),but the serum SCr increased(71.2vs.65.2,P=0.022)in the≥800mL group after operation.Conclusion The use of intraoperative autologous blood transfusion saved a lot of blood resources for the craniocerebral operation patients,and we found diabetes history,prolonged operation time maybe the influencing factors of intraoperative blood loss.In addition,intraoperative massive hemorrhage may result in the decrease of platelet count and the increase of serum SCr,which may affects the prognosis of patients.

关 键 词：颅脑占位手术 自体输血 异体输血 影响因素 

分 类 号：R982[医药卫生—药品]