剖宫产术中红细胞输注总量的影响因素分析  

Analysis of influencing factors on total amount of erythrocyte transfusion during cesarean section

作　　者：陈杰[1] 王树亚 吴文静 吴婵[2] 朱玉婷 韩晶晶 Chen Jie;Wang Shuya;Wu Wenjing;Wu Chan;Zhu Yuting;Han Jingjing(Department of Transfusion Medicine,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,Jiangsu Province,China;Department of Gynecology,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,Jiangsu Province,China;Department of Information,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,Jiangsu Province,China;Department of Clinical Laboratory,Children′s Hospital of Nanjing Medical University,Nanjing 210008,Jiangsu Province,China)

机构地区：[1]南京大学医学院附属鼓楼医院输血科,南京210008 [2]南京大学医学院附属鼓楼医院妇产科,南京210008 [3]南京大学医学院附属鼓楼医院信息科,南京210008 [4]南京医科大学附属儿童医院检验科,南京210008

出　　处：《国际输血及血液学杂志》2023年第1期75-83,共9页International Journal of Blood Transfusion and Hematology

基　　金：南京医学科技发展项目(YKK18059)。

摘　　要：目的探讨剖宫产术中产妇红细胞输注总量的影响因素。方法选择2018年1月至2021年6月于南京大学医学院附属鼓楼医院行剖宫产术并且术中接受红细胞输注的229例产妇为研究对象;并且根据术中红细胞输注总量,将其分为研究组(n=123,术中红细胞输注总量>2 U)和对照组(n=106,术中红细胞输注总量≤2 U)。采用回顾性研究方法,收集2组产妇的一般临床、术前实验室检测结果及术中输血相关资料,并采用成组t检验或Mann-Whitney U检验,对2组产妇的上述资料进行统计学比较。采用多因素非条件logistic回归分析方法,分析影响产妇剖宫产术中红细胞输注总量的独立影响因素;采用受试者工作特征(ROC)曲线,评估独立影响因素对产妇剖宫产术中红细胞输注总量>2 U的预测价值。本研究遵循的程序符合2013年修订版《世界医学协会赫尔辛基宣言》要求。结果①本研究研究组123例产妇剖宫产术中血浆输注量[350 mL(0,700 mL)比0(0,0)],冷沉淀凝血因子输注量[0(0,0)比0(0,0)],异体红细胞输注量[3 U(3.0,5.5 U)比0(0,1.5 U)],预存式自体输血(PABD)输注量[0(0,0)比1.5 U(0,1.5 U)],回收式自体输血(SAT)输注量[0(0,3 U)比0(0,0)],红细胞输注总量[4.5 U(3.0,8.0 U)比1.5 U(1.5,1.5 U)]均高于对照组,并且差异均有统计学意义(U=7.505、4.736、10.282、6.730、6.515、13.229,P<0.001)。②单因素分析结果显示,研究组产妇的孕周、产次、伴凶险性前置胎盘比例、伴胎盘植入比例、术前血细胞比容(HCT)、手术时间、术中失血量,均高于对照组,并且差异均有统计学意义(U/χ^(2)=3.459、6.371、7.205、7.194、-2.103、5.676、7.617,P=0.001、0.041、0.007、0.007、0.036、<0.001、<0.001)。③多因素非条件logistic回归分析结果显示,产妇孕周增加(OR=0.853,95%CI:0.732~0.993,P=0.041)和术前HCT升高(OR=0.872,95%CI:0.802~0.948,P=0.001)是剖宫产术中红细胞输注总量增加的独立保护因素,术中失血�Objective To investigate influencing factors of the total amount of erythrocyte transfusion for puerpera during cesarean section.Methods From January 2018 to June 2021,a total of 229 puerpera receiving intraoperative erythrocyte transfusion during cesarean section in Nanjing Drum Tower Hospital,Affiliated Hospital of Nanjing University Medical School were selected as research subjects.According to the total amount of intraoperative erythrocyte transfusion,they were divided into study group(n=123,total amount of intraoperative erythrocyte transfusion>2 U)and control group(n=106,total amount of intraoperative erythrocyte transfusion≤2 U).Using retrospective study method,the general clinical data,preoperative laboratory test results,and intraoperative blood transfusion related data of puerpera in two groups were collected.And group t test or Mann-Whitney U test were used to compare above data between two groups statistically.The independent influencing factors of total amount of erythrocyte transfusion during cesarean section were analyzed by multivariate unconditional logistic regression analysis.The receiver operating characteristic(ROC)curve was used to evaluate predictive value of independent influencing factors on total amount of erythrocyte transfusion>2 U during cesarean section.The procedures followed in this study were in accordance with the requirements of the Declaration of Helsinki of the World Medical Association revised in 2013.Results①In this study,blood transfusion volume of various blood components during cesarean section of 123 puerpera in study group,such as plasma[350 mL(0,700 mL)vs 0(0,0)],cryoprecipitated antihemophilic factor[0(0,0)vs 0(0,0)],allogeneic erythrocyte[3 U(3.0,5.5 U)vs 0(0,1.5 U)],preoperative autologous blood donation(PABD)[0(0,0)vs 1.5 U(0,1.5 U)],salvage autologous blood transfusion(SAT)[0(0,3 U)vs 0(0,0)],total amount of erythrocyte transfusion[4.5 U(3.0,8.0 U)vs 1.5 U(1.5,1.5 U)]were higher than those in control group,and the differences were statistically significant(U=7

关 键 词：剖宫产术 输血 红细胞输注 输血 自体 危险因素 孕妇 

分 类 号：R719.8[医药卫生—妇产科学]