主动脉夹层手术患者围术期输血情况及影响因素分析

摘要

Objective To analyze influence factors of perioperative blood transfusion in patients with aortic dissection surgery.Methods Clinical data of 318 patients who had aortic dissection surgery in Beijing Anzhen Hospital,Capital Medical University from January to December 2016 were analyzed retrospectively.Perioperative erythrocyte transfusion volume was recorded.The relation among plasma transfusion volume,erythrocyte transfusion volume and activated partial thromboplastin time (APTT) was analyzed by Pearson test.Influence factors of erythrocyte transfusion volume were analyzed by multiple linear logistic regression.Results In 318 patients,the average erythrocyte transfusion volume in female was significantly higher than that in male [(9 ±5)U vs (6 ±5)U] (P ＜0.05).In 306 patients who had cardiopulmonary bypass(CPB),the average erythrocyte transfusion volume in CPB time ＞ 200 min group (151 cases) was significantly higher than that in CPB time ＜200 min group (155 cases) [(9 ± 5) U vs (5 ± 4) U] (P ＜ 0.05).In 318 patients,57 patients (17.9％) were not transfused erythrocyte;261 patients (82.1％) with erythrocyte transfusion were divided into ＜ 5 U group (82 cases.),5-＜ 11 U group(109 cases),11-16 U group(47 cases) and ＞ 16 U group(23 cases).The length of hospital stay significantly increased with erythrocyte transfusion volume (P ＜ 0.05).Pearson analysis showed a significant positive correlation between plasma transfusion volume and erythrocyte transfusion volume (r =0.699,P ＜0.001);there was no correlation between plasma transfusion volume and ApTT (r =0.109,P =0.051).Logistic analysis showed that female and CPB time ＞ 200 min were influence factors of erythrocyte transfusion volume.Conclusion Female and CPB time ＞ 200 min were influence factors of perioperative erythrocyte transfusion volume in patients undergoing aortic dissection surgery.%目的 分析主动脉夹层手术患者围术期输血情况及影响因素.方法 回顾性分析2016年1-12月在首都医科大学附属北京安贞医院行主动脉夹层手术的318例患者的临床资料.记录患者围术期血浆和红细胞输注量,采用Pearson相关分析血浆输注量与红细胞输注量和部分活化凝血酶原时间(APTT)的关系,采用多元线形Logistic回归分析患者围术期红细胞输注量的影响因素.结果 在318例患者中,女性红细胞平均输注量高于男性[(9±5)U比(6±5)U],差异有统计学意义(P＜0.05).有12例患者未进行体外循环,在306例患者中,体外循环时间＞ 200 min组(151例)红细胞平均输注量高于体外循环时间≤200 min组(155例)[(9±5)U比(5±4)U],差异有统计学意义(P＜0.05).在318例患者中,围术期未输注红细胞患者57例(17.9％)为未输血组,围术期输注红细胞患者261例(82.1％)为红细胞输注组.根据红细胞输注量的不同,红细胞输注组分为＜5U组(82例)、5～＜11U组(109例)、11～16 U组(47例)、＞16 U组(23例).除了未输血组和＜5U组间外,随着红细胞平均输注量的增加,平均住院时间逐渐增加,差异均有统计学意义(均P＜0.05).Pearson相关分析结果显示,血浆输注量与红细胞输注量呈明显正相关(r =0.699,P＜0.001),与APTT不相关(r=0.109,P=0.051).多元线性Logistic回归分析显示女性和体外循环时间＞ 200 min是主动脉夹层手术患者围术期红细胞输注量的影响因素.结论 主动脉夹层手术患者围术期输血概率较大,女性和体外循环时间＞ 200 min是主动脉夹层手术患者围术期红细胞输注量的影响因素.