围手术期应用体外膜氧合支持肺移植受者输血影响因素分析  

Analysis of influencing factors for transfusion inperioperative extracorporeal membrane oxygenation supported lung transplantation recipients

作　　者：王琪[1] 王文静[1] 陈利达[1] 王璐璐[1] 赵儒 陈文慧 刘希曦[1] 芦宏凯[1] Wang Qi;Wang Wenjing;Chen Lida;Wang Lulu;Zhao Ru;Chen Wenhui;Liu Xixi;Lu Hongkai(Department of blood transfusion,China Japan Friendship Hospital,Beijing 100029,China;Institute of Respiratory Medicine,Chinese Academy of Medical Sciences Respiration Center of China-Japan Friendship Hospital National Clinical Research Center for Respiratory Diseases Lung Transplantation Center of China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]中日友好医院输血科,北京100029 [2]中国医学科学院呼吸病学研究院中日友好医院呼吸中心国家呼吸临床研究中心中日友好医院肺移植中心,北京100029

出　　处：《中华器官移植杂志》2021年第3期163-167,共5页Chinese Journal of Organ Transplantation

摘　　要：目的分析应用体外膜氧合(ECMO)的肺移植受者围手术期凝血和输血情况,为临床科学合理输血提供依据。方法回顾性分析2017年3月至2019年7月中日友好医院完成的178例肺移植受者的临床资料。根据围手术期是否应用ECMO,将178例受者分为有ECMO组(131例)和无ECMO组(47例),对两组受者的临床资料、实验室检查及输血情况进行比较。将131例有ECMO组的受者排除二次开胸止血7例、数据不全2例后,再分别按输血成分不同分为未输红细胞组(63例)和输红细胞组(59例)、输血浆量<1000 ml组(99例)和输血浆量≥1000 ml组(23例)、未输血小板组(93例)和输血小板组(29例),统计受者的临床资料、实验室检查和ECMO相关信息,用二元Logistic回归分析影响术后ECMO支持期间输血的危险因素。结果有、无ECMO两组受者在BMI、病程、原发病、双肺移植、实验室检查、术后输血量、术后红细胞和血浆输注比例方面的差异有统计学意义(P<0.05)。双肺移植、ASAⅣ级、术后ECMO支持时间≥2 d、术后HGB<100 g/L、术后PT/APTT/INR异常、术后PLT计数<100×10^(9)/L是术后ECMO期间输血的独立危险因素。结论肺移植围手术期应用ECMO支持受者,术后输血量和输血需求更大。充分评估受者输血需求、优化凝血监测方案、明确输血影响因素,有助于临床科学合理输血。Objective To evaluate perioperative coagulatory parameters and transfusion rates of lung transplantation recipients.Methods Clinical data were retrospectively reviewed for 178 lung transplant recipients at China-Japan Friendship Hospital from March 2017 to July 2019.According to whether extracorporeal membrane oxygenation(ECMO)was used during perioperative period,they were divided into two groups of ECMO(131 cases)and without ECMO(47 cases).Clinical data,laboratory examinations and blood transfusion status of two groups were compared.In ECMO group,excluding secondary thoracotomy for hemostasis(7 cases)and incomplete data(2 cases),the remainders were divided into the groups of no red blood cell transfusion(63 cases),red blood cell transfusion(59 cases),plasma transfusion<1000 ml(99 cases)and plasma transfusion≥1000 ml(23 cases),no platelet transfusion(93 cases)and platelet transfusion(29 cases).Clinical data,laboratory examinations and ECMO-related parameters of recipients were analyzed by Bary Logistic regression.Results Statistically significant inter-group differences existed in body mass index(BMI),disease course,primary disease,bilateral lung transplantation,laboratory examinations,postoperative blood transfusion volume,postoperative red blood cell and plasma transfusion ratio between groups with and without ECMO(P<0.05).Bilateral lung transplantation,ASA grade,differences in BMI,disease course,postoperative hemoglobin<100 g/L,postoperative PT/APTT/INR abnormalities and postoperative PLT count<100×10^(9)/L were independent risk factors for postoperative transfusion during ECMO.Conclusions The application of ECMO during lung transplantation may affect the perioperative transfusion volume and demand.Fully assessing blood transfusion requirements,optimizing coagulation monitoring and identifying the independent influencing factors of postoperative blood transfusion facilitate clinical scientific and rational blood transfusions.

关 键 词：肺移植 体外膜氧合 成分输血 危险因素 凝血 

分 类 号：R457.1[医药卫生—治疗学] R655.3[医药卫生—临床医学]