术中高血浆输注剂量对围手术期输血患者预后的影响  

Effect of high intraoperative plasma dose on the prognosis of patients undergoing blood transfusion during perioperative period

作　　者：李丹丹 黄国栋[1] 马正根 马伟 刘怡伶[1] LI Dandan;HUANG Guodong;MA Zhenggen;MA Wei;LIU Yiling(Department of Blood Transfusion,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510120,China;The Sixth Medical Center of the General Hospital of the People′s Liberation Army)

机构地区：[1]中山大学孙逸仙纪念医院输血科,广东广州510120 [2]中国人民解放军总医院第六医学中心

出　　处：《中国输血杂志》2024年第5期541-547,共7页Chinese Journal of Blood Transfusion

基　　金：中国人民解放军总医院第六医学中心创新培育基金(CXPY202007)。

摘　　要：目的探讨术中血浆输注剂量、凝血指标的变化与外科手术患者的临床预后之间的关系,为指导术中合理用血提供理论依据。方法收集孙逸仙纪念医院2017年1月—2020年12月术中接受血浆输注的556例外科手术患者的临床资料,并根据术中血浆输注剂量分为低输注剂量(<15 mL/kg)组和高输注剂量(≥15 mL/kg)组,通过单因素、Logistic多因素回归分析以及线性回归分析,探讨血浆输注剂量、凝血指标的变化与术后患者预后之间的关系。结果共有556例外科手术患者纳入研究,所有患者术后血浆输注剂量的中位数(四分位间距)为10.5(8.5~14.0)mL/kg。在多变量回归分析中,术中血浆输注剂量每增加1 mL/kg导致术后24 h内输注红细胞悬液的风险增加[OR(95%CI)1.16(1.01,1.33),P<0.05]、ICU住院天数增加[Mean(95%CI)0.19(0.03,0.35),P<0.05]以及医院住院天数增加[Mean(95%CI)0.55(0.27,0.81),P<0.05];术前INR的异常程度增加术后24 h内输注红细胞悬液的风险[OR(95%CI)1.82(1.33,2.50),P<0.05],增加术后患者的住院死亡率[OR(95%CI)2.15(1.09,4.24),P<0.05];术中血浆输注前后INR的下降幅度降低术后24 h患者输注红细胞的风险[OR(95%CI)0.47(0.27,0.84),P<0.05]以及减少住院死亡率[OR(95%CI)0.23(0.13,0.50),P<0.05]。结论在术中接受血浆输注的外科手术患者中,术前异常的INR值和术中高血浆输注剂量与较差的临床预后有关;而INR(输血前—输血后)较大的变化值与较好的临床结果有关。Objective To explore the relationship between the intraoperative plasma transfusion volume,the changes of blood coagulation test values and the clinical prognosis of surgical patients,so as to provide a theoretical basis for guiding the rational use of blood during the operation.Methods The clinical data of 556 surgical patients who received plasma infusion from January 2017 to December 2020 in Sun Yat-sen Memorial Hospital were collected.Patients were divided into low plasma dose group(<15 mL/kg)and high plasma dose group(≥15 mL/kg).The univariate regression analysis,logistic multivariate regression analysis and linear regression analysis were used to explore the relationship of plasma dose,the changes of coagulation indicators and the clinical prognosis.Results A total of 556 surgical patients were included in the study and the median(interquartile range)of plasma transfusion volume for all patients during the operation was 10.5(8.5~14.0)mL/kg.In multivariate regression analysis,an increase of 1 mL/kg of intraoperative plasma dose resulted in an increased risk of red blood cell infusion within 24 hours after surgery[OR(95%CI)1.16(1.01,1.33),P<0.05],an increase in the ICU stays[Mean(95%CI)0.19(0.03,0.35),P<0.05]and an increase in the hospitalization days[Mean(95%CI)0.55(0.27,0.81),P<0.05].The preoperative INR value increased the risk of red blood cell infusion within 24 hours after surgery[OR(95%CI)1.82(1.33,2.50),P<0.05],and increased the hospital mortality of postoperative patients[OR(95%CI)2.15(1.09,4.24),P<0.05];the decrease in INR reduced the risk of red blood cell infusion in patients 24 hours after surgery[OR(95%CI)0.47(0.27,0.84),P<0.05]and reduced hospital mortality[OR(95%CI)0.23(0.13,0.50),P<0.05].Conclusion In surgical patients undergoing intraoperative plasma infusion,abnormal preoperative INR value and high intraoperative plasma infusion are related to poor clinical prognosis,while INR decrease(preoperative-postoperative)was related to better clinical results.

关 键 词：血浆输注剂量 INR 外科手术 预后 

分 类 号：R457.1[医药卫生—治疗学] R61[医药卫生—临床医学]