儿童活体肝移植术中大量输血的危险因素  

Risk factors for massive blood transfusion in pediatric living donor liver transplantation

作　　者：单迦晨 宋九林 靳曙光[2] 向波[2] 杨家印[3] 张伟义[1] Shan Jiachen;Song Jiulin;Jin Shuguang;Xiang Bo;Yang Jiayin;Zhang Weiyi(Department of Anesthesiology,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Pediatric Surgery,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Hepatic Surgery,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院麻醉科,成都610041 [2]四川大学华西医院小儿外科,成都610041 [3]四川大学华西医院肝脏外科,成都610041

出　　处：《中华麻醉学杂志》2022年第2期151-154,共4页Chinese Journal of Anesthesiology

摘　　要：目的:筛选儿童活体肝移植术中大量输血的危险因素。方法:回顾性收集2006年4月至2019年4月本院活体肝移植患儿病历资料。大量输血定义为术中红细胞输注总量大于自身1倍总循环血容量(70 ml/kg)。根据术中输血量,将患儿分为大量输血组和非大量输血组。采用二元logistic回归分析筛选危险因素。结果:共纳入患儿95例,大量输血组18例,非大量输血组77例。术中大量输血发生率为19%。logistic回归分析显示,术前生存状态为"住院"(OR=49.816,95%CI 2.945~842.59,P=0.007)、血清Cr浓度升高(OR=1.046,95%CI 1.007~1.086,P=0.021)、儿童终末期肝病评分(PELD)或终末期肝病模型评分(MELD)升高(OR=1.215,95%CI 1.046~1.411,P=0.011)和手术时间延长(OR=1.623,95%CI 1.133~2.327,P=0.008)是术中大量输血的危险因素,受体体重增加(OR=0.856,95%CI 0.761~0.962,P=0.009)是术中大量输血的保护因素。结论:术前生存状态为"住院"、PELD或MELD评分升高和手术时间延长是儿童活体肝移植术中大量输血的危险因素,患儿体重增加是其保护因素。Objective To identify the risk factors for massive blood transfusion in pediatric living donor liver transplantation.Methods The medical data of children underwent living donor liver transplantation in our hospital from April 2006 to April 2019 were retrospectively collected.Massive transfusion was defined as the administration of red blood cells>1 fold of the total blood volume(70 ml/kg)during operation.Patients were assigned to massive transfusion group and non-massive transfusion group according to the volume of blood transfused during operation.Binary logistic regression analysis was used to identify the risk factors for massive blood transfusion during living liver transplantation.Results A total of 95 pediatric patients were enrolled in this study,with 18 cases in massive transfusion group and 77 cases in non-massive transfusion group.The incidence of massive blood transfusion was 19%during operation.The results of logistic regression analysis showed that preoperative survival status of"hospitalization"(OR=49.816,95%CI 2.945-842.59,P=0.007),increased serum Cr concentrations(OR=1.046,95%CI 1.007-1.086,P=0.021),increased Pediatric End-Stage Liver Disease(PELD)or Model for End-Stage Liver Disease(MELD)score(OR=1.215,95%CI 1.046-1.411,P=0.011)and prolonged operation time(OR=1.623,95%CI 1.133-2.327,P=0.008)were the independent risk factors for intraoperative massive blood transfusion in living donor liver transplantation,while increased recipient weight(OR=0.856,95%CI 0.761-0.962,P=0.009)was a protective factor for intraoperative massive blood transfusion.Conclusions Preoperative survival status of"hospitalization",increased PELD or MELD score and prolonged operation time are independent risk factors,while increased pediatric weight is a protective factor for massive blood transfusion in pediatric living donor liver transplantation.

关 键 词：儿童 肝移植 输血 危险因素 

分 类 号：R726.5[医药卫生—儿科]