Investigation on influencing factors of perioperative blood transfusion in mitral valve surgery
-
摘要: 目的：调研二尖瓣手术围术期输血现状，探讨影响输血的相关因素，从而加强临床血液管理。方法：收集大连地区3家三甲级医院接受二尖瓣手术患者189例，根据是否输注异体血分为异体输血组（109例）和未输异体血组（80例）；根据输血方式分为输异体血组（109例），自体输血组（39例）和（自体+异体）输血组（26例），未输血组（41例）。收集189例进行二尖瓣手术患者的基本信息（性别、年龄、临床诊断）、手术相关信息（手术时间、术中失血量）、术前血常规、凝血功能指标、患者转归情况（抗生素使用情况、住院天数）进行统计学分析。结果：二尖瓣手术患者围术期输异体血比例57.7%（109/189），患者总平均用血量（4.1±6.0）U。输异体血组和未输异体血组在年龄、手术时间、术前Hb、术前APTT、抗生素使用情况、住院天数方面差异有统计学意义（P<0.05）。患者围术期输血量与术前PLT、APTT有相关性（P<0.05），相关系数分别为-0.02、0.16。未输血组、自体输血组和（自体+异体）输血组在抗生素使用天数、住院天数方面优于异体输血组（P<0.05），未输血组、自体输血组在抗生素使用种类方面优于（自体+异体）输血组、异体输血组（P<0.05）。结论：对二尖瓣手术围术期是否输血的影响因素有年龄、手术时间、术前Hb、术前APTT。而输血量与术前PLT、术前APTT相关。异体输血组、（自体+异体）输血组、自体输血组、未输血组在对患者术后转归方面有统计学意义。Abstract: Objective: To explore the present situation and influencing factors of blood transfusion during the perioperative period in mitral valve surgery, in order to enforce the blood management.Method: A total of 189 patients receiving the mitral valve surgery from three hospitals in Dalian were divided into two groups including 109 patients for allogeneic blood transfusion and 80 for non-allogeneic blood transfusion, and four groups including 109 patients for allogeneic blood transfusion, 39 for autologous transfusion, 26 for allogeneic and autologous transfusion, 41 for non-blood transfusion.The data were collected and analyzed including patients' information(age, gender, diagnosis), operation information(operative time, bleeding volume during operation), blood routine test and coagulation test before operation as well as the postoperative recovery(antibiotics treatment, hospital stay).Result: 57.7% patients had allogeneic blood transfusion and the average volume was(4.1±6.0) U during the perioperative period.There were significant differences in age, operative time, Hb, APTT of pre-operation and antibiotics treatment, hospital stay between the allogeneic blood transfusion and the non-allogeneic transfusion group(P<0.05).Transfusion volume was well correlated with PLT and APTT of pre-operation(r=-0.02 and 0.16 respectively).The non-blood transfusion group, the autologous transfusion group and the allogeneic and autologous group were better than the allogeneic transfusion group in the antibiotics use days and the hospital stay(P<0.05).Meanwhile the non-blood transfusion group and the autologous transfusion group were better than that of other groups in the antibiotics types(P<0.05).Conclusion: Age, operative time, Hb, APTT of pre-operation were the main influencing factors of blood transfusion in mitral valve surgery.Transfusion volume was well correlated with PLT and APTT of pre-operation.There were significant differences in the postoperative recovery among the four groups.
-
-
[1] 陈小芳, 张杰, 王东进.术中输血量对心脏瓣膜置换术后肾功能的影响[J].实用临床医药杂志, 2011, 15(21):171-172.
[2] 邱志兵, 陈鑫, 杨婷, 等.闭式体外循环下直视微创手术与常规二尖瓣手术疗效的随机对照试验[J].中国胸心血管外科临床杂志, 2015, 22(1):4-8.
[3] 杨婷, 肖立琼, 张扬波, 等.微创体外循环和常规体外循环下行二尖瓣手术的对比研究[J].南京医科大学学报(自然科学版), 2014, 34(5):649-652.
[4] 吴晓燕, 陆艳, 宋国蓉.储存式自体血回输在心脏瓣膜置换术中的应用研究[J].中华全科学杂志, 2014, 12(1):53-55.
[5] 严敏, 田兆嵩.围手术期合理输血[M].北京:人民卫生出版社, 2014:229-232.
[6] 刘景汉, 李志强, 王海林.临床单病种输血[M].北京:人民卫生出版社, 2017:88-89.
[7] Yu PJ, Cassiere HA, Dellis SL, et al.Dose-dependent effects of intraoperative low volume red blood cell transfusions on postoperative outcomes in cardiac surgery patients[J].J Cardiothorac Vasc Anesth, 2014, 28:1545-1549.
[8] 孟毅, 董逸飞, 董书强.心脏瓣膜手术后早期住院死亡相关危险因素分析[J].临床军医杂志, 2011, 39(6):1073-1075.
[9] 黄焕雷, 谢旭晶, 张建军, 等.简化血液管理技术在心脏手术中的应用[J].中国胸心血管外科临床杂志, 2015, 22(11):1000-1004.
-
计量
- 文章访问数: 122
- PDF下载数: 56
- 施引文献: 0
下载: