术前肝功能对升主动脉手术患者围术期大量输血的预测价值  

Predictive value of preoperative liver function for perioperative massive blood transfusion in patients undergoing ascending aorta surgery

作　　者：钱丽慧 朱才民 赵章生 王磊[1] 周薇 忻其乐 马幼丽 牧启田[2] QIAN Lihui;ZHU Caimin;ZHAO Zhangsheng;WANG Lei;ZHOU Wei;XIN Qile;MA Youli;MU Qitian(The Affiliated Lihuili Hospital of Ningbo University,Ningbo 315040,China;The First Affiliated Hospital of Ningbo University)

机构地区：[1]宁波大学附属李惠利医院,浙江宁波315040 [2]宁波大学附属第一医院

出　　处：《中国输血杂志》2023年第12期1118-1123,共6页Chinese Journal of Blood Transfusion

摘　　要：目的探讨术前肝功能对升主动脉手术患者围术期大量输血(MBT)的预测价值。方法收集在宁波大学附属李惠利医院心脏大血管外科接受升主动脉手术患者资料共238例,术前均进行肝功能检测。根据患者围术期红细胞悬液输注量,将患者分为MBT组(n=42)、非MBT组(n=153)和无输血(NBT)组(n=43),比较不同组间患者围术期临床资料;采用受试者工作特征(ROC)曲线分析肝功能指标对MBT的预测价值,确定相应临界值。结果MBT组分别与非MBT组、NBT组比较,术前天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、直接胆红素(DBIL)、血清白蛋白(SA)均有差异(P<0.05);ROC曲线分析显示,AST预测MBT的曲线下面积(AUC)最大,为0.723;ALT预测MBT的特异度最高,为86.7%;SA预测MBT的灵敏度最高,为89.7%。当AST>28.50 U/L,ALT>40.00 U/L,SA≤34.55 g/L,DBIL>4.25μmol/L时,患者各血液成分输注量及MBT发生率显著增加。结论术前肝功能指标(AST、ALT、SA、DBIL)对升主动脉手术患者围术期MBT具有中等预测价值。Objective To explore the predictive value of preoperative liver function for massive blood transfusion(MBT)in patients undergoing ascending aorta surgery.Methods Data from 238 patients undergoing ascending aorta surgery in the Department of Cardiovascular Surgery at The Affiliated Lihuili Hospital of Ningbo University were collected.Preoperative liver function tests were performed for all patients.Based on the perioperative transfusion volumes of red blood cell suspension,patients were divided into the MBT group,non-MBT group,and no blood transfusion(NBT)group.Clinical data during the perioperative period were compared among different groups.Receiver operating characteristic curve(ROC curve)analysis was used to assess the predictive value of liver function indicators for MBT and determine cut-off values.Results Compared with the non-MBT group and NBT group,the MBT group showed statistically significant differences in preoperative levels of aspartate aminotransferase(AST),alanine aminotransferase(ALT),direct bilirubin(DBIL),and serum albumin(SA)(P<0.05).ROC curve analysis revealed that AST had the largest area under the curve(AUC)for predicting MBT,with a value of 0.723.ALT had the highest specificity for predicting MBT at 86.7%,and SA had the highest sensitivity at 89.7%.When AST>28.50 U/L,ALT>40.00 U/L,SA≤34.55 g/L,and DBIL>4.25μmol/L,there was a significant increase in the transfusion volume of various blood components and the incidence of MBT.Conclusion Preoperative liver function indicators(AST,ALT,SA,DBIL)have a moderate predictive value for MBT in patients undergoing ascending aorta surgery.

关 键 词：肝功能 天门冬氨酸氨基转移酶 升主动脉手术 A型主动脉夹层 大量输血 

分 类 号：R457.1[医药卫生—治疗学] R615[医药卫生—临床医学]