A型主动脉夹层患者围术期大量输血的危险因素分析  

Analysis of the risk factors of perioperative massive blood transfusion in patients undergoing type A aortic dissection surgery

作　　者：郑宇佳 高旭蓉[1] 张继雁 贾金娜[1] 高原[1] 纪宏文[1] Zheng Yujia;Gao Xurong;Zhang Jiyan;Jia Jinna;Gao Yuan;Ji Hongwen(Department of Blood Transfusion,Fuwai Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院,北京协和医学院,阜外医院输血科,100037

出　　处：《北京医学》2021年第8期795-799,共5页Beijing Medical Journal

摘　　要：目的探讨A型主动脉夹层患者围术期大量输血的危险因素及对患者转归的影响。方法选取2016年6月至2017年12月中国医学科学院北京协和医学院阜外医院行A型主动脉夹层手术的患者332例,收集患者的临床资料、相关实验室指标、各种血液成分用量及患者转归数据。根据红细胞用量分为大量输血组(红细胞用量≥20 U)与非大量输血组(红细胞用量<20 U),采用logistic回归分析确定大量输血的危险因素。结果332例患者中大量输血组18例。年龄(P=0.013)、手术时间(P<0.001)、术后6 h胸液量(P=0.006)和再次开胸止血术(P<0.001)是A型主动脉夹层患者围术期大量输血的危险因素。大量输血组术后呼吸机使用时间[115.5(40.8,202.0)h比22.0(15.0,43.5)h]、重症监护室(intensive care unit,ICU)停留时间[11.5(5.5,21.0)d比5.0(3.0,6.0)d]和住院时间[22.0(19.8,27.3)d比15.0(12.0,19.0)d]均延长,术后贫血[87.0(84.0,109.0)g/L比102.0(91.0,111.0)g/L]、低氧血症(22.2%比5.1%)、感染(27.8%比8.3%)、肾功能不全(33.3%比2.5%)和住院病死率(33.3%比3.5%)均增高,差异有统计学意义(P<0.05)。结论年龄、术中止血困难致手术时间延长、术后早期出血过多和再次开胸止血是A型主动脉夹层患者围术期大量输血的危险因素。大量输血与患者并发症和住院病死率呈正相关。Objective To explore the risk factors of massive blood transfusion in patients undergoing type A aortic dissection surgery and its effect on the outcome of patients during hospitalization.Methods Continuous type A aortic dissection surgical procedures from June 2016 to December 2017 were reviewed.Clinical data,relevant laboratory indexes,dosage of various blood components and patient outcome data were documented and analyzed.According to the amount of red blood cells transfusion they were divided into massive transfusion group(RBC transfusion≥20 U)and non-massive transfusion group(RBC transfusion<20 U).Logistic regression analysis was used to determine risk factors for massive blood transfusion-Results A total of 332 patients were analyzed,in which 18 were in the massive transfusion group.Age(P=0.013),operation time(P<0.001),pleural fluid volume six hours after operation(P=0.006)and reoperation for hemostasis(P<0.001)were risk factors for perioperative massive blood transfusion in patients undergoing type A aortic dissection surgery.The ventilation time,ICU length of stay and hospital length of stay were prolonged,and the proportion of lower postoperative Hb,hypoxemia,infection,renal insufficiency and in-hospital mortality were increased in the massive transfusion group(P<0.05).Conclusions Age,prolonged operation time due to hemostasis difficulties,early postoperative excessive bleeding,and reoperation for hemostasis are risk factors for perioperative massive blood transfusion undergoing type A aortic dissection patients.Massive blood transfusion increases complications and in-hospital mortality.

关 键 词：主动脉夹层 围术期 大量输血 危险因素 转归 

分 类 号：R654.3[医药卫生—外科学] R457.1[医药卫生—临床医学]