华西综合血液管理策略减少体外循环患者异体血需要  

Huaxi integrated blood management reduces the requirements of allogenic blood for patients undergoing cardiopulmonary bypass

作　　者：刘侠丽 谭赵霞 秦臻[1] 喻翔 汪勃 周秀娟 刘婷[1] 罗明[1] 李呤雨 周荣华[1] 杜磊[1] 熊际月[1] Liu Xiali;Tan Zhaoxia;Qin Zhen;Yu Xiang;Wang Bo;Zhou Xiujuan;Liu Ting;Luo Ming;Li Lingyu;Zhou Ronghua;Du Lei;Xiong Jiyue(Department of Anesthesiology,West China Hospital,Sichuan University,Chengdu 614000,China)

机构地区：[1]四川大学华西医院麻醉科,成都610041

出　　处：《中国体外循环杂志》2022年第4期200-206,225,共8页Chinese Journal of Extracorporeal Circulation

基　　金：四川大学华西医院135卓越发展计划资助项目(2017-120)

摘　　要：目的本研究拟评价体外循环中华西综合血液管理(HIBM)策略对患者异体血需要量的影响。方法回顾性分析四川大学华西医院于2019年1月1日至2020年12月31日在体外循环下行成人心血管手术患者。HIBM包括减少预充量、逆预充技术、机血管理等9项策略。根据策略实施的时间,将患者分为实施前、推行期、全面实施。主要预后指标为围术期血制品使用量和使用率。结果3292例患者纳入分析,其中实施前为2265例、推行期318例,全面实施709例。与实施前比较,HIBM实施后全主动脉弓置换等大血管手术比例更高(14.7%vs.22.7%,P<0.001)而瓣膜置换手术比例较少(76.1%vs.67.0%,P<0.001);HIBM实施前后比较,血制品输注量红细胞(RBC)、新鲜冰冻血浆(FFP)、血小板(PLT)分别为:2.43 U vs.0.42 U;0.78 U vs.0.15 U;0.53 U vs.0.13 U、输注率(RBC、FFP、PLT分别为:47.0%vs.10.0%,23.0%vs.5.5%,35.0%vs.9.2%)均显著降低(所有P<0.001)。逻辑回归分析显示,HIBM能显著降低患者异体血暴露风险(RBC:OR=0.13,95%CI:0.10~0.16;FFP:OR=0.18,95%CI:0.13~0.26;PLT:OR=0.19,95%CI:0.14~0.25)。不同手术类型亚组分析也得出相似结果。结论HIBM能显著减少体外循环下心血管手术患者的输血量和异体血暴露风险,值得推广。Objective To reduce the requirement of blood,Huaxi integrated blood management strategy(HIBM)was devel⁃oped from June 12020,and has implemented in all adult patients since Aug.1.This study was to evaluate the effect of HIBM on allo⁃geneic blood requirements.Methods Patients over 18 years of age who underwent on-pump cardiovascular surgery in West China Hospital of Sichuan University from Jan.1,2019 to Dec.31,2020 were retrospectively analyzed.The HIBM included 9 strategies,in⁃cluding reduction of prime volume,retrograde autologous priming,and reduction of residual blood in circuit.Patients were divided into control group(prior to May 31,2020),partial-blood management group(from June 1,2020 to July 31,2020),and HIBM group(after Aug.1,2020).The primary outcome was the requirement of blood products.Results We enrolled 3292 patients in the analy⁃sis,including 2265 in control group,318 in partial-HIBM group,and 709 in HIBM group.There were more patients with total aortic arch replacement(14.7%vs 22.7%,P<0.001)and fewer with valve surgeries(76.1%vs 67.0%,P<0.001)located in HIBM group compared with control group.However,the blood products requirement(red cells:2.43 units/case vs 0.42 units/case;fresh frozen plasma:0.78 units/case vs 0.15 units/case;platelet:0.53 units/case vs 0.13 units/case)and exposure(red cells:47.0%vs 10.0%,fresh frozen plasma:23.0%vs 5.5%,platelet:35.00%vs 9.2%)were less in HIBM group than control group.Multivariate logistic re⁃gression showed that HIBM significantly reduced the risk of blood products exposure(red cell:OR:0.13;95%CI:0.10-0.16;fresh frozen plasma:OR:0.18;95%CI:0.13-0.26;platelet:OR:0.19;95%CI:0.14-0.25).Subgroup analyses reached similar results.Conclusion Huaxi integrated blood management strategy significantly reduces the requirements of blood products and the risk of their exposures in patients undergoing on-pump cardiovascular surgery.HIBM is worth to be recommended.

关 键 词：综合血液管理策略 心血管手术 体外循环 输血 血液保护 

分 类 号：R614[医药卫生—麻醉学]