急性Stanford A型主动脉夹层患者围术期用血情况分析  

Analysis of perioperative blood transfusion in patients with acute Stanford type A aortic dissection surgery

作　　者：张少强[1] 刘青[2] 孟子凡 刘术臻[1] ZHANG Shaoqiang;LIU Qing;MENG Zifan;LIU Shuzhen(Department of Blood Transfusion,The Affiliated Hospital of Qingdao University,Qingdao 266003,China;Department of Clinical Laboratory,The Affiliated Hospital of Qingdao University,Qingdao 266003,China)

机构地区：[1]青岛大学附属医院输血科,山东青岛206003 [2]青岛大学附属医院检验科,山东青岛206003

出　　处：《中国输血杂志》2024年第9期1018-1022,共5页Chinese Journal of Blood Transfusion

摘　　要：目的回顾性分析本院322例Stanford A型主动脉夹层患者的输血情况,探讨患者围术期血液输注的影响因素及效果评价。方法选择2020年10月-2023年10月本院行手术治疗的Stanford A型主动脉夹层患者,分析不同手术方式间血液输注的差异、血常规及凝血功能指标监测,对大量血液输注的影响因素进行评价。结果Stanford A型主动脉夹层患者中术中异体红细胞输注率63.98%,围术期异体红细胞输注率85.71%。行Bentall手术术中红细胞、血浆、冷沉淀、血小板输注量分别为(3.75±3.81)U、(608.13±314.77)mL、(15.25±8.39)U、(1.53±0.78)治疗量,与行Sun′s手术的输注量(3.13±4.04)U、(707.61±461.21)mL、(15.79±6.59)U、(1.54±0.64)治疗量及行Bentall手术+Sun′s手术患者术中的输注量(3.04±4.41)U、(813.48±582.02)mL、(18.39±6.43)U、(1.76±0.58)治疗量比较无差异(P>0.05)。术前Hb行Bentall手术治疗患者(127.75±23.17)g/L及行Sun′s手术治疗患者(126.07±16.14)g/L明显低于行Bentall手术+Sun′s手术治疗患者(133.17±18.12)g/L(P<0.05),术后Hb、APTT以及Plt组间比较无差异(P>0.05)。围术期红细胞大量输注者占53.42%,大量输注组住院天数(23.83±9.74 d)明显高于常规输注组(31.71±22.98 d),大量输注组死亡率34.88%高于常规输注组5.33%(P<0.05),大量输注组出院Hb(95.65±11.58)g/L低于常规输注组(101.93±15.77)g/L(P<0.05)。结论血液输注是保证急性Stanford A型主动脉夹层患者围术期治疗的必要措施,红细胞大量输注伴随死亡率增加,住院时间延长,凝血功能的检测有利于指导血液成分的使用,采用个性化的限制性输血策略可以减少不必要的输血,保障患者安全。Objective To retrospectively analyze the blood transfusion of 322 patients with Stanford type A aortic coarctation in our hospital,and to explore the influencing factors of perioperative blood transfusion in patients and evaluate the effect.Methods The patients with Stanford A type aortic coarctation who underwent surgical treatment in our hospital from October 2020 to October 2023 were selected to analyze the differences in blood transfusion and the monitoring of blood routine and coagulation function between different surgical modalities,and to evaluate the influencing factors of massive blood transfusion.Results The intraoperative allogeneic red blood cell transfusion rate was 63.98%and the perioperative allogeneic red blood cell transfusion rate was 85.71%in patients with Stanford type A aortic coarctation.The intraoperative red blood cell,plasma,cryoprecipitates and platelet transfusion volumes for the Bentall procedure were(3.75±3.81)U,(608.13±314.77)mL,(15.25±8.39)U and(1.53±0.78)therapeutic doses,respectively,and had no difference compared with those for Sun′s procedure with the transfusion volume of(3.13±4.04)U,(707.61±461.21)mL,(15.79±6.59)U and(1.54±0.64)therapeutic doses and those for Bentall&Sun’s procedure with the transfusion volume of(3.04±4.41)U,(813.48±582.02)mL,(18.39±6.43)U and(1.76±0.58)therapeutic doses(P>0.05).Preoperative hemoglobin levels were significantly lower in patients treated with Bentall procedure(127.75±23.17)g/L and in patients treated with Sun′s procedure(126.07±16.14)g/L than in patients treated with Bentall&Sun′s procedure(133.17±18.12)g/L(P<0.05).Postoperative hemoglobin,APTT and platelet counts were not statistically different between groups(P>0.05).Perioperative erythrocyte massive infusion accounted for 53.42%.The length of hospital days(days)in the massive transfusion group(23.83±9.74)was significantly higher than that in the conventional transfusion group(31.71±22.98),and the mortality rate in the massive infusion group 34.88%was significantly h

关 键 词：主动脉夹层 体外循环 血液输注 凝血功能监测 

分 类 号：R457.1[医药卫生—治疗学] R543.1[医药卫生—临床医学] R654.1