预防性输注血浆对ICU患者不同侵入性操作术后出血率的影响  

Effect of prophylactic plasma transfusion on postoperative bleeding rate in ICU patients after different invasive procedures

作　　者：任琪 赵洁[2] 贺雪花 苏莉[4] 柴巨川 柏灵灵[6] 敖正才[7] 巫彩霞 谢宇頔 李玲[1] 刘忠[1] REN Qi;ZHAO Jie;HE Xuehua;SU Li;CHAI Juchuan;BAI Lingling;Ao Zhengcai;WU Caixia;XIE Yudi;LI Ling;LIU Zhong(Institute of Blood Transfusion,Chinese Academy of Medical Sciences&Peking Union Medical College;Sichuan Academy Of Medical Sciences,Sichuan Provincial People's Hospital;Shanxi Bethune Hospital;Guizhou Provincial People's Hospital;Zibo Central Hospital;The Third People's Hospital of Chengdu;Chengdu Fifth People's Hospital)

机构地区：[1]中国医学科学院/北京协和医学院输血研究所,四川成都610052 [2]四川省医学科学院·四川省人民医院 [3]山西白求恩医院 [4]贵州省人民医院 [5]淄博市中心医院 [6]成都市第三人民医院 [7]成都市第五人民医院

出　　处：《中国输血杂志》2022年第10期1027-1031,共5页Chinese Journal of Blood Transfusion

基　　金：中国医学科学院医学与健康科技创新工程(2021-1-I2M-060);四川省国际科技创新合作/港澳台科技创新合作项目(2020YFH0024)。

摘　　要：目的评估接受不同侵入性操作的重症患者预防性输注血浆与术后出血率之间的关联。方法回顾性调查国内6家三甲医院2019年1月~2019年12月期间接受不同侵入性操作的ICU患者的信息,患者的纳入标准为:年龄≥18岁;接受侵入性操作;术前72 h内检测INR≥1.5。排除标准为病例记录不完整的患者。最终纳入研究的患者依据其血浆输注情况,分为预防性输注血浆组及未预防性输注血浆组。结果变量是不同侵入性操作后48 h内与侵入性操作相关的出血发生。结果本研究共有407例患者接受侵入性操作,排除45例符合排除标准的患者,最终纳入362例患者。预防性血浆输注在不同类型侵入性操作的比例分别为中心静脉置管术(46/146,31.5%)、胸腔穿刺术(13/37,35.1%)、支气管镜检查(8/31,25.8%)、气管插管(9/38,23.7%)、动脉导管插入术(9/50,18.0%),其他侵入性检查(13/60,21.7%);出血率结果显示,不同侵入性操作接受血浆输注组与未接受血浆输注组之间均没有统计学差异;在预防性输注血浆组中,动脉导管插入术出血率(4/9,44.4%)最高,但均为潜在出血,其次为气管插管(4/10,40.0%)及中心静脉置管(16/46,34.8%),其明显出血率较高。结论预防性输注血浆未能降低不同侵入性操作术后出血率,但需要前瞻性研究进一步证实该结论;本研究为后期前瞻性研究的开展提供一定的数据基础。Objective To evaluate the association between prophylactic plasma transfusion and postoperative bleeding rate in critically ill patients undergoing different invasive procedures.Methods The information of ICU patients who received different invasive procedures from January 2019 to December 2019 in 6 tertiary hospitals in China were retrospectively investigated.The inclusion criteria of patients were as follows:age≥18 years;received invasive procedures;INR≥1.5 within 72 hours before surgery.Exclusion criteria were patients with incomplete case records.The patients finally included in the study were divided into prophylactic plasma transfusion group and non-prophylactic plasma transfusion group according to their plasma transfusion status.The outcome variable was the incidence of invasive procedure-related bleeding within 48 hours after different invasive procedures.Results A total of 407 patients underwent invasive procedures,and 362 patients were finally included in this study after excluding 45 patients with incomplete case records.The proportions of prophylactic plasma transfusion in different types of invasive procedures were central venous catheterization(46/146,31.5%),thoracentesis(13/37,35.1%),bronchoscopy(8/31,25.8%),tracheal intubation(9/38,23.7%),arterial catheterization(9/50,18.0%)and others(13/60,21.7%).The bleeding rates showed that different invasive procedures presented no statistical difference between the groups received plasma transfusion or not.In the prophylactic plasma transfusion group,the bleeding rate of arterial catheterization(4/9,44.4%)was the highest,but all were potential bleeding,followed by tracheal intubation(4/10,40.0%)and central venous intubation(16/46,34.8%),with a higher rate of significant bleeding.Conclusion Prophylactic infusion of plasma did not reduce the bleeding rate after different invasive procedures,but prospective studies are needed to further confirm the conclusion;this study also provides a certain data basis for later prospective studies.

关 键 词：侵入性操作 预防性输注血浆 出血 

分 类 号：R457.14[医药卫生—治疗学]