原位肝移植患者输血因素与术后早期转归的关系  

Relationship between blood transfusion factors and early postoperative outcomes in patients undergoing orthotopic liver transplantation

作　　者：李志华[1] 王春晓 刘春晓[1] 赵梅竹 张鑫[1] 赵东[1] 郄晓娟[1] 郝立净[1] Li Zhihua;Wang Chunxiao;Liu Chunxiao;Zhao Meizhu;Zhang Xin;Zhao Dong;Qie Xiaojuan;Hao Lijing(Department of Anesthesiology,The Third Hospital of Hebei Medical University,Shijiazhuang 050051,China)

机构地区：[1]河北医科大学第三医院麻醉科,石家庄050051

出　　处：《中华麻醉学杂志》2023年第2期156-161,共6页Chinese Journal of Anesthesiology

摘　　要：目的评价原位肝移植患者输血因素(大量输血、输注储存血及无肝期输血)与术后早期转归的关系。方法回顾性选取本院2021年1月至2022年3月终末期肝病行原位肝移植术且术中输血的患者,收集患者临床资料。根据患者术中的输血量分为大量输血组(M组,红细胞总输注量≥10 U)和非大量输血组(NM组),根据输注红细胞的储存时间分为新鲜血组(NS组)和储存血组(S组,红细胞储存时间>2周),根据无肝期是否输血分为无肝期输血组(T组)和非无肝期输血组(NT组)。采用多因素logistic回归、广义线性模型及广义线性混合模型分别分析输血因素与主要结局指标(术后肺部并发症、循环超负荷、急性肾损伤、腹腔感染、血栓形成)和次要结局指标(ICU滞留时间、术后住院时间、术后任一时点体温≥38.5℃、术后肝肾功能指标、凝血功能指标、血小板计数与术前的差值)的关系。结果本研究纳入患者106例。多因素logistic回归分析结果:大量输血与输注储存血是术后肺部并发症的危险因素,大量输血是腹腔感染的危险因素,肝功能Child-Turcotte-Pugh评分和无肝期时间是术后急性肾损伤的危险因素,Child-Turcotte-Pugh评分是循环超负荷的危险因素,年龄和大量输血是血栓形成的危险因素(P<0.05)。广义线性模型分析结果:术中输注储存血和无肝期输血是ICU滞留时间延长的危险因素,大量输血、术中输注储存血和无肝期输血是住院时间延长的危险因素(P<0.05),大量输血、术中输注储存血和无肝期输血与术后任一时点体温≥38.5℃无相关性(P>0.05)。广义线性混合模型分析结果:是否大量输血、是否输注储存血以及是否无肝期输血患者术后肝肾功能指标、凝血功能指标、血小板计数与术前的差值差异有统计学意义(P<0.05)。结论大量输血及输注储存血是原位肝移植患者术后早期不良转归的危险因素。Objective To evaluate the relationship between blood transfusion factors(massive transfusion,transfusion of stored red blood cells and anhepatic transfusion)and early postoperative outcomes in the patients undergoing orthotopic liver transplantation.Methods Patients with end-stage liver disease who underwent orthotopic liver transplantation and intraoperative blood transfusion from January 2021 to March 2022 in our hospital were retrospectively selected,and their clinical data were collected.The patients were divided into massive transfusion group(M group,total red blood cell transfusion≥10 U)and non-massive transfusion group(NM group)according to the amount of intraoperative blood transfused.The patients were divided into fresh blood group(NS group)and stored blood group(S group,red blood cell storage time>2 weeks)according to the storage time of red blood cells transfused.The patients were divided into transfusion in anhepatic stage group(group T)and nontransfusion in anhepatic stage group(group NT)according to whether blood was transfused in the anhepatic stage.Multivariate logistic regression,generalized linear model and generalized linear mixed model were used to analyze the relationship between blood transfusion factors and primary outcome measures(postoperative pulmonary complications,circulation overload,acute kidney injury,abdominal infection,thrombosis)and between blood transfusion factors and secondary outcome measures(duration of ICU stay,postoperative hospitalization,postoperative temperature≥38.5℃at any time point after surgery,postoperative liver and kidney function index,coagulation function index,platelet count and preoperative difference).Results One hundred and six patients were enrolled in this study.The results of multivariate logistic regression analysis:Massive blood transfusion and infusion of stored blood were risk factors for postoperative pulmonary complications,massive blood transfusion was a risk factor for abdominal infection,Child-Turcotte-Pugh score for liver function and tim

关 键 词：肝移植 输血 预后 

分 类 号：R614[医药卫生—麻醉学]