体外循环心脏手术限制输血的回顾性研究

摘要

Objective To evaluate effect of blood transfusion standard as hemoglobin (Hb) <90 g/L after cardiopulmonary bypass cardiac surgery.Methods There were 201 patients receiving cardiopulmonary bypass cardiac surgery during 2011~2014 as limited group, and another 163 patients meeting selection standard during 2008~2010 as conventional group. On the basis of applying multiple blood conservation measures, the limited group took hemoglobin <90 g/L as the postoperative blood transfusion standard, while the conventional group took its standard as hemoglobin <100 g/L. A retrospective comparison was made on blood transfusion condition and postoperative outcomes between the two groups.Results The limited group had all lower cell transfusion rate as 55.7% and dosage as (1.9±2.0)U than 92.0% and (5.2±2.5) U in the conventional group (P<0.01). The limited group also had lower average dosage of fresh frozen plasma than the conventional group [(360.1±221.2)ml VS (605.2±200.6)ml,P<0.01]. There was no statistically significant difference of platelet transfusion rate between the two groups (10.9% VS 10.4%,P>0.05). Mortality of the two groups in ICU stay had no statistically significant difference (P>0.05), and the limited group had shorter postoperative hospital stay than the conventional group (P<0.05).Conclusion Implement of hemoglobin <90 g/L as the blood transfusion standard after cardiopulmonary bypass cardiac surgery for non-severe patients can reduce blood transfusion rate and dosage and save a large amount of blood resources, without any influence on curative effect by surgery.%目的 评价以血红蛋白(Hb)<90 g/L作为体外循环心脏手术术后输血标准的效果.方法 2011~2014年入组择期体外循环心脏手术患者201例作为限制组, 2008~2010年手术中符合入组标准的163例患者作为常规组.在采取多项血液保护措施的基础上, 限制组以血红蛋白<90 g/L作为术后输血标准, 常规组以血红蛋白<100 g/L为标准, 回顾性比较两组患者输血情况及术后转归情况.结果 限制组红细胞输注率为55.7%, 用量为(1.9±2.0)U, 均较常规组的92.0%、(5.2±2.5)U降低(P<0.01), 限制组新鲜冰冻血浆平均用量较常规组亦有降低[(360.1±221.2)ml VS (605.2±200.6)ml,P<0.01], 血小板输注率两组比较差异无统计学意义(10.9% VS 10.4%,P>0.05).两组患者ICU停留时间、死亡率比较差异无统计学意义(P>0.05), 限制组手术后住院时间较常规组短(P<0.05).结论 非重症患者体外循环心脏术后以血红蛋白<90 g/L作为输血标准, 减少了输血率和输血量, 不影响手术疗效, 节省了大量的血液资源.