Preoperative hemoglobin level and platelet count in predicting risk of perioperative erythrocyte transfusion in cardiothoracic surgery
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摘要: 目的 探讨术前血红蛋白水平(Hb)和血小板计数(PLT)对心胸外科围手术期红细胞输注的危险预测价值。方法 回顾性分析2020年1月至2021年4月进行心胸外科手术的患者124例，根据是否发生术后感染分为感染组(16例)和未感染组(108例)，分析其一般临床资料、感染发生率及发生的类型，Cox模型分析影响术后感染的危险因素，ROC曲线分析术前Hb和PLT对术后感染的预测诊断价值。结果 感染组和未感染组的年龄、术前Hb、术前PLT、低蛋白血症、输血量比较，差异有统计学意义(P< 0.05)；感染的发生率为12.9%，以呼吸道感染为主(50%)；Cox模型分析发现年龄、术前Hb、术前PLT、低蛋白血症是术后感染的独立危险因素；ROC曲线分析发现术前Hb和术前PLT联合诊断的曲线下面积为0.989 2，95%CI：0.965 7~1.013 0，高于二者单独检测的预测价值。结论 心胸外科围术期红细胞输注容易发生术后感染，术前Hb和PLT的联合检测对于术后感染的危险预测具有良好的诊断价值。Abstract: Objection To investigate the value of preoperative hemoglobin level and platelet count in predicting the risk of perioperative erythrocyte transfusion in cardiothoracic surgery.Methods A total of 124 patients undergoing cardiothoracic surgery in our hospital from January 2020 to April 2021 were analyzed retrospectively. They were divided into infection group and non-infection group according to whether postoperative infection occurred. The general clinical data, the incidence and types of infection were analyzed. Cox model was used to analyze the risk factors of postoperative infection. ROC curve analysis of preoperative hemoglobin and platelet count in the prediction and diagnosis of postoperative infection.Results There were significant differences in age, preoperative hemoglobin, preoperative platelet count, hypoproteinemia and blood transfusion between infected group and uninfected group(P< 0.05). The incidence of infection was 12.9%, mainly respiratory tract infection, accounting for 50%. Cox model analysis showed that age, preoperative hemoglobin, preoperative platelet count and hypoproteinemia were independent risk factors for postoperative infection. The ROC curve analysis showed that the area under the curve for the combined diagnosis of preoperative hemoglobin and preoperative platelet count was 0.989 2, and the 95%CI: 0.965 7-1.013 0, which was higher than the predictive value of their separate detection.Conclusion Perioperative red blood cell infusion in cardiothoracic surgery is prone to postoperative infection. The combined detection of preoperative hemoglobin and platelet count has good diagnostic value for the risk prediction of postoperative infection.
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Key words:
- hemoglobin /
- platelet count /
- cardiothoracic surgery /
- blood transfusion /
- infected
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表 1 术后感染组与未感染组临床基线资料比较
X ±S 组别 感染组(16例) 未感染组(108例) P 性别(男︰女)/例 10︰6 68︰40 >0.05 年龄/岁 53.2±10.7 52.4±11.2 < 0.05 BMI/(kg·m-2) 24.3±1.6 24.1±1.3 >0.05 吸烟/例(%) 9(56.3) 53(49.1) >0.05 高血压/例(%) 10(62.5) 66(61.1) >0.05 糖尿病/例(%) 4(25.0) 25(23.1) >0.05 高脂血症/例(%) 3(18.8) 21(19.4) >0.05 COPD/例(%) 1(6.3) 4(3.7) >0.05 低蛋白血症/例(%) 3(18.8) 3(2.8) < 0.05 术前Hb/(g·L-1) 93.65±0.94 121.72±0.89 < 0.05 术前PLT/(×109·L-1) 102.42±10.15 134.65±9.83 < 0.05 术前Cr/(μmol·L-1) 116.43±89.02 121.57±92.48 >0.05 手术时间≥3 h/例(%) 9(56.3) 65(60.2) >0.05 手术创伤/例(%) 1(6.3) 3(2.8) >0.05 缺血-再灌注损伤/例(%) 2(12.5) 3(2.8) >0.05 应激反应/例(%) 1(6.3) 4(3.7) >0.05 激素用药史/例(%) 2(12.5) 11(10.2) >0.05 术前ALB/(g·L-1) 37.36±4.71 46.52±4.82 >0.05 术前营养不良/例(%) 5(31.3) 38(35.2) >0.05 术前Lac 3.31±2.54 2.78±2.16 >0.05 术前LVEF/% 59.58±10.36 61.23±11.24 >0.05 气管插管≥3 d/例(%) 10(62.5) 48(44.4) >0.05 输血量≥400 mL/例(%) 8(50.0) 28(25.9) < 0.05 
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表 2 Cox模型分析心胸外科围术期红细胞输注的危险因素
因素 B SE Wald χ2 P RR 95%CI 年龄 0.104 0.335 7.968 0.032 1.268 1.037~6.512 术前Hb 0.132 0.480 8.642 0.014 1.109 1.126~6.496 术前PLT 0.036 0.527 8.511 0.025 1.436 1.266~7.480 低蛋白血症 0.021 0.618 6.903 0.036 1.564 1.308~6.561 输血量 0.130 0.711 6.425 0.064 1.007 1.339~5.428
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