颅颌面畸形矫形术中回收式自体输血患者异体输血合理性研究及大量输血预防性护理效果  

Research on reasonableness of allogeneic blood transfusion in patients with autologous blood transfusion and preventive nursing efficacy of massive transfusion in orthopedic surgery for craniofacial deformity

作　　者：王颖[1] 王烨 支延康[1] WANG Ying;WANG Ye;ZHI Yankang(Department of Plastic and Reconstructive Surgery,Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China;Department of Anesthesiology,Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院整复外科,上海市200011 [2]上海交通大学医学院附属第九人民医院麻醉科,上海市200011

出　　处：《组织工程与重建外科》2023年第6期553-557,共5页Journal of Tissue Engineering and Reconstructive Surgery

摘　　要：目的了解颅颌面畸形矫形术中接受回收式自体输血患者异体红细胞输注情况,评价异体输血合理性;研究不合理输血危险因素;建立此类手术中合理异体红细胞输血决策模型;评价大量输血预防性护理措施效果。方法以接受颅颌面畸形大型矫形术并接受回收式自体输血的患者为研究对象,评估术中回收的自体血输注完毕后患者的理论血红蛋白值,将大于100 g/L还接受异体红细胞输注的情况定义为不合理输血。比较不合理输血患者与合理输血患者各项临床指标差异,通过回归模型研究不合理输血相关危险因素。应用人工智能神经网络算法建立此类手术合理异体红细胞输血决策模型。通过回顾围术期输血不良反应评价大量输血预防性护理措施效果。结果本研究共纳入术中回收式自体输血患者63名,其中异体红细胞输注率为96.83%(61/63),异体红细胞不合理输注率为36.07%(22/61)。回归模型未发现导致不合理输血的相对独立危险因素。合理异体红细胞输血决策模型ROC曲线下面积接近100%。此类手术中使用大量输血预防性护理措施后未发现输血相关严重并发症。结论颅颌面畸形矫形术中回收式自体输血患者不合理异体红细胞输注现象较严重;建议术中根据出血量及自体血回输量变化,随时运用本研究模型评估异体红细胞输注必要性,避免不合理异体输血;针对此类手术大量输血预防性护理措施效果确切。Objective To understand the allogeneic red blood cell infusion in patients with autologous blood transfusion and evaluate the reasonableness of allogeneic blood transfusion in orthopedic surgery for craniofacial deformity;To explore the risk factors for unreasonable blood transfusion;To establish a decision-making model for reasonable allogeneic red blood cell infusion in this type of surgery;And to assess the preventive nursing efficacy of massive transfusion.Methods The patients who received extensive operations on craniofacial deformity and autologous blood transfusion were selected as research objects.The theoretical hemoglobin value after the completion of intraoperative salvaged autologous blood transfusion at the end of operations was estimated,and unreasonable blood transfusion was defined as being greater than 100 g/L and receiving allogeneic red blood cell infusion.The differences in various clinical indexes between unreasonable blood transfusion patients and other patients were compared,and the risk factors related to unreasonable blood transfusion were analyzed via the regression model.Artificial intelligence neural network algorithm was used to establish a decision-making model for reasonable allogeneic red blood cell infusion in this type of surgery.The preventive nursing efficacy of massive transfusion was assessed by reviewing adverse reactions in perioperative blood transfusion.Results A total of 63 patients with intraoperative autologous blood transfusion were included in this study,of which the allogeneic red blood cell infusion rate was 96.83%(61/63)and the unreasonable allogeneic red blood cell infusion rate was 36.07%(22/61).The regression model did not find relatively independent risk factors that lead to unreasonable allogeneic blood transfusion.The area under the ROC curve in the decision-making model for reasonable allogeneic red blood cell infusion was close to 100%.After using a lot of preventive nursing measures for blood transfusion in this type of surgery,no serious complications re

关 键 词：颅颌面畸形 术中回收式自体输血 血液管理 

分 类 号：R457.1[医药卫生—治疗学] R622[医药卫生—临床医学]