主动脉弓部置换术围术期大量输注红细胞危险因素分析  

Analysis of the risk factors of perioperative massive infusion of red blood cells in patients with aortic dissection undergoing aortic arch replacement

作　　者：费忠化[1] 蔡腾 蔡国强[1] 张春英[1] 刘宏[1] FEI Zhonghua;CAI teng;CAI Guoqiang;ZHANG Cunying;LIU Hongsheng(Department of Cardiovascular ICU,Affiliated Hospital of Jining Medical University,Jining 272029,China)

机构地区：[1]济宁医学院附属医院心脏重症医学科,272029

出　　处：《心肺血管病杂志》2022年第7期797-800,805,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：山东省自然科学基金(ZR202102280514);山东省高等学校科技计划基金(J17KA231)。

摘　　要：目的:探讨行主动脉弓部置换术的主动脉夹层(AD)患者围术期大量输注红细胞(RBC)的危险因素。方法:回顾性分析2013年1月至2021年8月,行主动脉弓部置换的AD患者232例,术中和术后24h内输注RBC总量≥8U为大量输血组(131例),<8U为常规输血组(101例),比较两组临床资料,采用多因素Logistic回归分析围术期大量输注RBC的危险因素。结果:大量输血组患者年龄大,女性占比高,合并冠心病、中等量心包积液、术前冠状动脉受累、行冠状动脉旁路移植比例高,体外循环(CPB)和主动脉阻断时间长,术中及术后24h内出血量多,与常规输血组比较,差异均有统计学意义(P<0.05),多因素回归分析女性(OR=3.653,95%CI:1.511~8.833,P=0.004)、术前Hb<130g/L(OR=3.616,95%CI:1.732~7.549,P=0.001)、CPB时间>200min(OR=3.374,95%CI:1.552~7.335,P=0.002)、术中出血≥1500mL(OR=5.079,95%CI:2.442~10.567,P=0.001)是行主动脉弓部置换术AD患者围术期大量输注RBC的危险因素。结论:行主动脉弓部置换术AD患者围术期RBC输注量大,大量输注RBC的危险因素包括女性、术前Hb<130g/L、CPB时间>200min、术中出血≥1500mL。Objective:To explore the risk factors of perioperative massive infusion of red blood cells(RBC)in patients with aortic dissection(AD)surgery undergoing aortic arch replacement.Methods:232 patients with AD who underwent aortic arch replacement surgery from January 2013 to August 2021 were analyzed retrospectively.The perioperative data were collected.According to the clinical perioperative blood transfusion status within 24 hours after surgery,patients were divided into massive transfusion group(≥8 RBC units n=131)and routine transfusion group(<8 RBC units,n=101).The clinical data of the two groups were compared.The risk factors of massive transfusion during perioperative period were analyzed by univariate and multivariate logistic regression.Results:The patients in the massive transfusion group were older,with a high proportion of women,complicated with coronary heart disease,moderate pericardial effusion,preoperative coronary artery involvement,high proportion of coronary artery bypass grafting,long time of cardiopulmonary bypass(CPB)and aortic occlusion,and more bleeding during and within 24 hours after operation.Compared with the routine transfusion group,the difference was statistically significant(P<0.05).Multivariate regression analysis showed that female(OR=3.653,95%CI:1.511-8.833,P=0.004),preoperative hemoglobin<130g/L(OR=3.616,95%CI:1.732-7.549,P=0.001),CPB time>200min(OR=3.374,95%CI:1.552-7.335,P=0.002)and intraoperative bleeding≥1500mL(OR=5.079,95%CI:2.442-10.567,P=0.001)were an independent risk factors of massive perioperative RBC infusion in AD patients undergoing aortic arch replacement.Conclusion:AD patients undergoing aortic arch replacement have a large amount of perioperative RBC infusion.The independent risk factors of massive RBC infusion include female,preoperative hemoglobin<130g/L,CPB time>200min and intraoperative bleeding≥1500mL.

关 键 词：主动脉弓 主动脉夹层 体外循环 输血 红细胞 

分 类 号：R54[医药卫生—心血管疾病]