北京市六家医疗机构心血管外科手术患者术前贫血情况及其对临床结局的影响  

Preoperative anemia and clinical impact on patients undergoing cardiovascular surgery in six medical institutions in Beijing

作　　者：高洁[1] 高原[2] 杨永涛 王军[4] 张亚南[5] 纪宏文[1] Gao Jie;Gao Yuan;Yang Yongtao;Wang Jun;Zhang Ya'nan;Ji Hongwen(Department of Anesthesiology,Fuwai Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100037,China)

机构地区：[1]中国医学科学院,北京协和医学院,阜外医院麻醉科,100037 [2]中国医学科学院,北京协和医学院,阜外医院输血科,100037 [3]北京华信医院清华大学第一附属医院输血科 [4]北京大学第三医院输血科 [5]首都医科大学附属北京天坛医院输血科

出　　处：《北京医学》2024年第12期1088-1092,共5页Beijing Medical Journal

基　　金：中国医学科学院创新工程项目(2021-I2M-1-060)。

摘　　要：目的探讨北京市医疗机构心血管外科手术患者术前贫血情况及其与术后临床结局的关系。方法选取2023年3月1~31日阜外医院、清华大学第一附属医院、北京大学第三医院、首都医科大学北京天坛医院、首都医科大学附属北京朝阳医院以及北京大学人民医院共6家北京市医疗机构行择期心血管外科手术的成年患者1107例,根据术前Hb分为非贫血组(n=958)、轻度贫血组(n=143)和中度贫血组(n=6)。比较患者围术期红细胞输血需求、急性肾损伤(acute kidney injury,AKI)和再次开胸止血手术的发生率。结果1107例患者中,男771例,女336例,年龄18~82岁,平均(57.3±12.3)岁。其中非贫血患者958例(86.5%),轻度贫血患者143例(12.9%),中度贫血患者6例(0.5%)。冠状动脉旁路移植术是最常见的手术类型。与非贫血组相比,术前贫血患者失血量、术后24 h纵隔胸腔引流量、总住院时间、红细胞输血需求、AKI及再次开胸止血手术发生率增加;中度贫血组人FIB和人凝血酶原复合物使用量也显著增加,差异均有统计学意义(P<0.05)。术前贫血是围术期红细胞输血需求(OR=2.507,95%CI:1.546~4.056,P<0.001)、AKI(OR=5.479,95%CI:1.556~19.290,P<0.05)及再次开胸止血手术发生率(OR=4.361,95%CI:1.129~16.843,P<0.05)增加的独立危险因素。结论术前贫血会增加患者围术期红细胞输血需求、AKI及再次开胸止血手术发生率。对此类患者应进行早期干预,以改善临床结局。Objective To explore the prevalence of preoperative anemia and the relationship between preoperative hemoglobin and postoperative clinical outcomes in patients undergoing cardiovascular surgery in medical institutions in Beijing.Methods A total of 1107 adult patients undergoing cardiovascular surgery in six medical institutions(including Fuwai Hospital,the First Affiliated Hospital of Tsinghua University,Peking University Third Hospital,Beijing Tiantan Hospital,Beijing Chaoyang Hospital,and Peking University People's Hospital)in Beijing from March 1 to March 31,2023 were selected,and were divided into non-anemia group(n=958),mild anemia(n=143)and moderate anemia(n=6)according to preoperative Hb.The perioperative red blood cell transfusion rate,the incidence of acute kidney injury(AKI)and reoperation for hemostasis were compared.Results Among the 1107 patients,there were 771 males and 336 females,aged from 18 to 82 years,with an average of(57.3±12.3)years.Among them,958(86.5%)were non-anemia patients,143(12.9%)were mild anemia patients,and six(0.5%)were moderate anemia patients.Coronary artery bypass grafting was the most common surgical procedure.Compared with the non-anemia group,the blood loss,24 h postoperative mediastinal thoracic drainage,total hospitalization time,red blood cell transfusion demand,the incidence of AKI and reoperation for hemostasis of the anemia group were increased.The dosage of human FIB and human prothrombin complex in moderate anemia group were also increased significantly,and the difference was statistically significant(P<0.05).Preoperative anemia was an independent risk factor for the increase of perioperative red blood cell transfusion demand(OR=2.507,95%CI:1.546-4.056,P<0.001),the incidence of AKI(OR=5.479,95%CI:1.556-19.290,P<0.05)and reoperation for hemostasis(OR=4.361,95%CI:1.129-16.843,P<0.05).Conclusions Preoperative anemia will increase the demand for perioperative red blood cell transfusion,the incidence of AKI and reoperation for hemostasis.Early intervention should be carr

关 键 词：术前贫血 心血管外科手术 红细胞输血 急性肾损伤 再次开胸止血手术 血液管理 

分 类 号：R69[医药卫生—泌尿科学]