肺移植患者围术期输血的影响因素分析  

Independent Risk Factors of Perioperative Blood Transfusion in Lung Transplantation

作　　者：王文静[1] 刘希曦[1] 芦宏凯[1] 王琪[1] 王璐璐[1] 郭伟洁[1] 曹永彤[2] WANG Wen-jing;LIU Xi-xi;LU Hong-kai(Department of Transfusion,China-Japan Friendship Hospital,Beijing 100029)

机构地区：[1]中日友好医院输血科,北京100029 [2]中日友好医院检验科

出　　处：《临床输血与检验》2021年第5期556-560,共5页Journal of Clinical Transfusion and Laboratory Medicine

摘　　要：目的本文通过分析肺移植患者围术期的实验室检查、手术和出凝血情况,找出肺移植患者围术期输血的独立危险因素,为临床预测用血和合理备血提供依据。方法回顾性分析我院2017年7月~2020年7月完成的260例肺移植患者的临床资料。根据患者围术期是否输注异体血,将患者分为无输血组(n=46)和输血组(n=214),对两组患者的临床资料、实验室检查情况进行比较。统计患者的基本信息、手术情况、术前和术后实验指标及体外膜肺氧合相关信息,进行单因素和二元Logistic回归分析,确定影响输血的危险因素。结果两组患者临床资料单因素分析在病程>7年(P<0.05)、ASAⅣ级(P<0.01)、双肺移植(P<0.001)、供体冷缺血时间>340 min(P<0.05)、肺移植手术时长>250 min(P<0.001)、术中出血量>400 mL(P<0.001)、术前Hb降低(P<0.05)、术前Hct降低(P<0.05)、术前PT>15 s(P<0.05)、术后PT>15 s(P<0.05)、术后PTA<80%(P<0.05)、术后APTT>43.5 s(P<0.001)方面的差异具有统计学意义。把单因素分析中P<0.1的指标纳入二元Logistic回归分析,结果显示,术后第一次APTT>43.5 s、双肺移植、术中出血量>400 mL、使用ECMO、病程年>7年是肺移植患者围术期输血的独立危险因素。结论术后第一次APTT>43.5 s、双肺移植、术中出血量>400 mL、围术期使用ECMO循环支持、病程超过7年会增加肺移植患者输血风险。充分评估手术方式,改善术前凝血功能和血红蛋白水平,有助于临床科学合理备血。Objective This study was to define independent risk factors of perioperative blood transfusion in patient who need a lung transplant using laboratory findings,operation methods and bleeding complications to provide the basis for clinical prediction of blood use and blood products preparation.Methods The medical records of 260 lung transplant patients in our hospital from July 2017 to July 2020 were retrospectively reviewed.These patients were divided into nontransfusion group(n=46)and blood transfusion group(n=214)according to receipt of perioperative blood transfusion.The clinical data and laboratory examinations were compared between two groups.Clinical and laboratory variables,such as patients'basic information,surgical conditions,preoperative and postoperative laboratory examinations,and extracorporeal membrane oxygenation(ECMO)related information,were compared using univariate analysis,and binary logistic regression were performed.Results In the univariate analysis,the difference between the two groups in disease course more than 7 years(P<0.05),ASAⅣ(P<0.01),double lung transplantation(P<0.001),donor cold ischemia time>340 min(P<0.05),lung transplantation duration>250 min(P<0.001),blood loss>400 mL(P<0.001),preoperative Hb reduction(P<0.05),preoperative Hct reduction(P<0.05),preoperative PT>15 s(P<0.05),postoperative PT>15 s(P<0.05),postoperative PTA<80%(P<0.05),postoperative APTT>43.5 s(P<0.001)showed statistically significant.The index of P<0.1 in univariate analysis were performed in binary logistic regression analysis.The results showed that the postoperative APTT>43.5 s,double lung transplantation,intraoperative blood loss>400 mL,ECMO use,disease course>7 years were independent risk factors for perioperative blood transfusion in lung transplantation.Conclusion The postoperative APTT>43.5 s,double lung transplantation,intraoperative blood loss>400 mL,perioperative use of ECMO,and disease duration more than 7 years increased risk for blood transfusion.Evaluation of surgical methods and improvement of pr

关 键 词：肺移植 体外膜肺氧合 异体输血 凝血功能 

分 类 号：R457[医药卫生—治疗学]