Risk factors of alogeneic blood transfusion volume during posterior orthopedic surgery in juvenile patients with scoliosis
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摘要: 目的 探讨未成年人脊柱侧凸患儿行后路矫形术中异体悬浮少白细胞红细胞(ASLRRBC)输注量的危险因素，为临床合理备血提供依据。方法 选取南京大学医学院附属鼓楼医院2021年1月至12月行后路矫形术的432例未成年人脊柱侧凸患儿，其中男140例，女292例；年龄(13.1±3.1)岁。根据患儿术中ASLRRBC输血量分为2组，术中输注ASLRRBC≤3 U组286例和术中输注ASLRRBC>3 U组146例。记录人体重指数(BMI)、病程、脊柱侧凸类型、术前血红蛋白(Hb)、血小板计数(PLT)、凝血指标、术中出血量、手术时长、切口以及术中ASLRRBC、异体血浆、冷沉淀、血小板输注量。以上资料进行组间比较，采用单因素分析以及二分类logistic回归分析筛选出未成年人脊柱侧凸患儿后路矫形术中ASLRRBC输注量的危险因素。结果 432例未成年人脊柱侧凸患儿行后路矫形术中平均输注ASLRRBC(3.0±1.5) U。ASLRRBC≤3 U组的患儿术中总输血量、ASLRRBC输血量和其他异体成分血(血浆、冷沉淀、血小板)输注率均显著低于ASLRRBC>3 U组，差异有统计学意义(Z=13.0、P < 0.001，t=26.1、P < 0.001，χ2=96.1、P < 0.001，χ2=29.3、P < 0.001，χ2=4.6、P=0.032)。单因素分析中，2组间年龄、病程、脊柱侧凸类型构成比、手术时长、术中出血量的差异有统计学意义(P < 0.05)。二分类logistic回归分析中，年龄增长(OR=1.003，95%CI 1.002~1.004，P=0.001)，病程延长(OR=1.004，95%CI 0.998~1.010，P=0.019)，手术时长(OR=1.007，95%CI 1.003~1.010，P=0.001)，术中出血量增多(OR=1.002，95%CI 1.002~1.003，P < 0.001)是术中ASLRRBC输注量增多的独立危险因素。结论 年龄较大、病程偏长、手术时间较久以及术中出血量较多的未成年人脊柱侧凸患儿行后路矫形术中ASLRRBC的输注量较大。可根据患儿的临床资料预估其术中ASLRRBC输注量，从而指导临床合理备血。Abstract: Objective To explore the risk factors of alogeneic suspended leukocyte reduced red blood cells(ASLRRBC) transfusion volume during posterior orthopedic surgery in juvenile patients with scoliosis and provide a basis for clinical rational blood preparation.Methods A total of 432 juvenile patients with scoliosis who underwent posterior orthopedic surgery from January to December 2021 in the Drum Tower Hospital Affiliated to Nanjing University School of Medicine were selected, including 140 males and 292 females, aged(13.1±3.1) years. The patients were divided into two groups according to volume of ASLRRBC transfused during posterior orthopedic surgery: ASLRRBC≤3 U group 286 cases and ASLRRBC>3 U group 146 cases. BMI, duration of disease, type of scoliosis, preoperative Hb, PLT, coagulation indexes, intraoperative blood loss, operation time, incision, and transfusion volumes of ASLRRBC, allogeneic plasma, allogeneic cryoprecipitate and allogeneic platelet during surgery were recorded. The above data were compared between groups, and univariate and multivariate regression analysis were used to screen out the risk factors of ASLRRBC infusion volume during posterior orthopedic surgery for juvenile patients with scoliosis.Results The transfusion volume of ASLRRBC during surgery of 432 juvenile patients with scoliosis were (3.0±1.5) U. The transfusion volume of total blood, ASLRRBC and the transfusion rate of allogeneic plasma, allogeneic cryoprecipitate and allogeneic platelet during surgery in the ASLRRBC≤3 U group were significantly lower than those in the ASLRRBC>3 U group, and the differences were all statistically significant(Z=13.0, P < 0.001, t=26.1, P < 0.001, χ2=96.1, P < 0.001, χ2=29.3, P < 0.001, χ2=4.6, P=0.032). Univariate regression analysis showed that the differences in age, duration of disease, composition ratio of scoliosis types, intraoperative blood loss and operation time of patients between two groups were statistically significant(P < 0.05). Logistic regression analysis identified that increase of age(OR=1.003, 95%CI 1.002-1.004, P=0.001), prolonged duration of disease(OR=1.004, 95%CI 0.998-1.010, P=0.019), prolonged operation time(OR=1.007, 95%CI 1.003-1.010, P=0.001), increase of intraoperative blood loss(OR=1.002, 95%CI 1.002-1.003, P < 0.001) were independent risk factors for increase of ASLRRBC transfusion volume during posterior orthopedic surgery in juvenile patients with scoliosis.Conclusion Juvenile patients with scoliosis who were older, had a longer disease duration, longer operative time and a more volume of intraoperative blood loss, might have an greater volume of ASLRRBC transfusion during posterior orthopedics surgery. According to relevant clinical characteristics, the volume of ASLRRBC transfusion during posterior orthopedic surgery could be estimated, thus guide reasonable blood preparation for clinical.
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Key words:
- scoliosis /
- posterior correction surgery /
- blood transfusion /
- risk factors /
- juvenile
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表 1 2组患儿术中总输血量及各成分血输注情况比较
组别 例数 总输血量/mL ASLRRBC输血量/U 异体血浆输注率/例(%) 异体冷沉淀输注率/例(%) 异体血小板输注率/例(%) >3 U组 146 1 400.0(1 050.0，1 842.5) 4.7±1.4 73(50.0) 22(15.1) 5(3.4) ≤3 U组 286 667.5(487.5，900.0) 2.2±0.6 24(8.4) 5(1.7) 1(0.3) Z/t/χ2 13.0 26.1 96.1 29.3 4.6 P < 0.001 < 0.001 < 0.001 < 0.001 0.032 
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表 2 432例未成年脊柱侧凸患儿后路矫形术中输注ASLRRBC的单因素分析
因素 ASLRRBC>3 U组(n=146) ASLRRBC≤3 U组(n=286) Z/t/χ2 P 年龄/岁 13.2±2.8 13.1±3.3 0.116 0.031 性别/例(%) 0.022 0.882 男 48(32.9) 92(32.2) 女 98(67.1) 194(67.8) BMI/(kg/m2) 18.2±3.4 18.8±3.5 -1.049 0.758 术前Hb/(g/L) 131.1±17.0 135.6±13.8 -2.964 0.082 术前PLT(×109/L) 259.6±66.3 263.1±62.9 -0.533 0.390 术前PT/s 11.8±0.7 11.6±0.7 2.259 0.579 术前INR 1.0±0.7 1.0±0.6 2.310 0.717 术前APTT/s 29.1±2.6 28.7±2.3 1.241 0.112 术前TT/s 17.5±0.9 17.5±0.9 0.194 0.849 术前Fib/(g/L) 2.3±0.5 2.3±0.4 -0.963 0.882 术前D二聚体/(g/L) 0.2(0.1，0.4) 0.2(0.1，0.3) 0.932 0.351 病程/月 15.0(3.0，48.0) 12.0(2.0，36.0) 2.399 0.016 脊柱侧凸类型/例(%) 45.370 < 0.001 特发性脊柱侧凸 132(90.4) 266(93.0) 先天性脊柱侧凸 1(0.7) 4(1.4) 神经肌肉性脊柱侧凸 6(4.1) 5(1.7) 神经纤维瘤型脊柱侧凸 4(2.7) 8(2.8) 其他型脊柱侧凸 3(2.1) 3(1.0) 手术时长/min 292.8±77.7 238.8±61.5 7.304 0.004 术中出血量/mL 1 200.0(900.0，1 600.0) 700.0(500.0，900.0) 10.306 < 0.001 切口/cm 34.0±9.2 31.4±11.3 1.832 0.150
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表 3 二分类logistic回归变量含义及赋值
因素 变量名 赋值 术中ASLRRBC输血量 Y Y=0为术中ASLRRBC输注量≤3 U，Y=1为术中ASLRRBC输注量>3 U 年龄 X1 — 病程 X2 — 脊柱侧凸类型 X3 1=特发性脊柱侧凸，2=先天性脊柱侧凸，3=神经肌肉性脊柱侧凸，4=神经纤维瘤型脊柱侧凸，5=其他 手术时长 X4 — 术中出血量 X5 — “—”为连续性变量，未进行赋值。
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表 4 未成年人脊柱侧凸患儿后路矫形术中ASLRRBC输注量>3 U的logistic回归分析
因素 β SE Wald P OR 95%CI 年龄 0.003 0.042 10.791 0.001 1.003 1.002~1.004 病程 0.004 0.003 1.683 0.019 1.004 0.998~1.010 手术时长 0.007 0.002 10.577 0.001 1.007 1.003~1.010 脊柱侧凸类型 特发性脊柱侧凸 0.664 0.956 先天性脊柱侧凸 -0.754 1.204 0.392 0.531 0.470 0.044~4.978 神经肌肉性脊柱侧凸 0.073 0.787 0.009 0.926 1.076 0.230~5.027 神经纤维瘤型脊柱侧凸 -0.311 0.674 0.213 0.644 0.733 0.196~2.744 其他类型脊柱侧凸 0.212 1.017 0.044 0.835 1.237 0.169~9.075 术中出血量 0.002 < 0.001 48.950 < 0.001 1.002 1.002~1.003
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[1] Bartley CE, Yaszay B, Bastrom TP, et al. Perioperative and Delayed Major Complications Following Surgical Treatment of Adolescent Idiopathic Scoliosis[J]. J Bone Joint Surg Am, 2017, 99(14): 1206-1212.
[2] Dupuis C, Michelet D, Hilly J, et al. Predictive factors for homologous transfusion during paediatric scoliosis surgery[J]. Anaesth Crit Care Pain Med, 2015, 34(6): 327-332. doi: 10.1016/j.accpm.2015.04.003
[3] Kato S, Chikuda H, Ohya J, et al. Risk of infectious complications associated with blood transfusion in elective spinal surgery-a propensity score matched analysis[J]. Spine J, 2016, 16(1): 55-60.
[4] Maher KM, Owusu-Akyaw K, Zhou J, et al. Analysis of the impact of race on blood transfusion in pediatric scoliosis surgery[J]. Paediatr Anaesth, 2018, 28(4): 352-360. doi: 10.1111/pan.13352
[5] 宋建申, 侯百灵, 马正良. 青少年脊柱侧弯后路矫形术术中液体管理研究进展[J]. 国际麻醉学与复苏杂志, 2021, 42(1): 58-63.
[6] 郁金凤, 刘婷婷, 李平, 等. 脊柱侧弯儿童和青少年患者后路矫形术中异体悬浮红细胞输注量的影响因素分析[J]. 国际输血及血液学杂志, 2021, 44(3): 241-246.
[7] 陈洪波. 严重创伤患者大量输血治疗对凝血功能的临床研究[J]. 血栓与止血学, 2021, 27(1): 75-76. https://www.cnki.com.cn/Article/CJFDTOTAL-XSZX202101029.htm
[8] 姚超峰, 李会广. 大量输血方案对急性创伤患者凝血功能纤溶功能及血栓弹力图监测结果的影响[J]. 中国药物与临床, 2021, 21(6): 992-994. https://www.cnki.com.cn/Article/CJFDTOTAL-YWLC202106047.htm
[9] 邵长会, 张董瑜, 冯琪, 等. 急性等容血液稀释联合术中血液回收对脊柱骨折患者术中血液保护的效果[J]. 中华创伤杂志, 2020, 36(11): 1010-1017.
[10] 邹艳, 林云, 何海涛, 等. 儿童青少年脊柱侧弯的影响因素研究[J]. 预防医学, 2022, 34(4): 395-399. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYFX202204015.htm
[11] Dunn J, Henrikson NB, Morrison CC, et al. Screening for Adolescent Idiopathic Scoliosis: Evidence Report and Systematic Review for the US Preventive Services Task Force[J]. JAMA, 2018, 319(2): 173-187.
[12] Weinstein SL. The Natural History of Adolescent Idiopathic Scoliosis[J]. J Pediatr Orthop, 2019, 39(Issue 6, Supplement 1 Suppl 1): S44-S46.
[13] Meert KL, Kannan S, Mooney JF. Predictors of red cell transfusion in children and adolescents undergoing spinal fusion surgery[J]. Spine(Phila Pa 1976), 2002, 27(19): 2137-2142.
[14] 郑曼, 张萍, 张媛, 等. 脊柱侧弯矫形术中出血与输血影响因素的探讨[J]. 中国输血杂志, 2009, 22(2): 134-136. https://www.cnki.com.cn/Article/CJFDTOTAL-BLOO200902017.htm
[15] 王立鹏, 赵鑫, 刘欢, 等. 青少年特发性脊柱侧弯后路矫形术后输血的危险因素分析: 一项单中心回顾性分析[J]. 国际麻醉学与复苏杂志, 2018, 39(8): 751-754, 778. https://www.cnki.com.cn/Article/CJFDTOTAL-KMYX202211019.htm
[16] 王利民, 王平, 刘善凤, 等. 血栓弹力图评估胰腺癌患者凝血功能状态及鉴别诊断的应用[J]. 临床血液学杂志, 2021, 34(4): 225-228. https://lcxy.whuhzzs.com/article/doi/10.13201/j.issn.1004-2806.2021.04.001
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