摘要
目的分析影响Stanford A型主动脉夹层患者术中输注红细胞量的因素,为此类患者科学用血、合理用血提供参考依据。方法收集2018年6月—2019年5月河南省人民医院心脏中心收治的主动脉夹层病例进行回顾性研究,整理患者相关病例资料,将患者分为术中输注RBC>4U组和术中输注RBC≤4U组,对比两组患者相关临床指标,并分析术中RBC输注量的影响因素。结果 102例行孙氏手术的Stanford A型主动脉夹层病例,术中输注RBC>4U组共45例,术中输注RBC≤4U组共57例。对比两组患者一般情况,主要包括年龄、性别、体重,是否患有高血压、糖尿病、冠心病、马凡综合征等疾病,近期吸烟史以及左心室射血分数、血红蛋白、血细胞比容、血小板计数,术中是否采用自体输血以及深体温停循环时间和体外转流时间等。两组间比较,其中年龄、高血压和体外转流时间的差异有统计学意义,P值分别为0.037、0.029和<0.001;两组间其他各项临床指标相比较,差异无统计学意义,均为P>0.05。多因素Logistic回归分析显示,高血压和体外转流时间是Stanford A型主动脉夹层患者术中RBC输注量的主要影响因素,P值分别为0.021和<0.001。对比两组患者的术后并发症、术后RBC输注量、ICU住院天数、总住院天数以及院内死亡情况,术中输注RBC≤4U组的患者术后RBC输注量和ICU住院天数明显少于术中输注RBC>4U组,P值分别为0.032和0.001。结论高血压可以减低Stanford A型夹层术中输注RBC的风险,较长的体外转流时间会增加Stanford A型夹层术中输注RBC的风险,术中输注RBC量较多者,可能会导致ICU住院天数延长。
Objective To analyze the factors that affect the amount of red blood cells infused during the operation of Stanford type A aortic dissection, so as to provide references for the scientific and reasonable use of blood in such patients.Methods From June 2018 to may 2019, the patients with aortic dissection admitted to the heart center of Henan Provincial People’s Hospital were collected for retrospective study, and the relevant case data were sorted out. The patients were divided into two groups: the group with intraoperative RBC transfusion > 4 U and the group with intraoperative RBC transfusion ≤ 4 U. The relevant clinical indicators of the two groups were compared and the influencing factors of intraoperative RBC transfusion were analyzed.Results Totally 102 cases of Stanford type A aortic dissection underwent sun’s operation, 45 cases in the group with intraoperative RBC transfusion > 4 U and 57 cases in the group with intraoperative RBC transfusion ≤ 4 U. The general conditions of the two groups were compared, mainly including age, gender, weight, hypertension, diabetes, coronary heart disease, Marfan syndrome and recent smoking history, left ventricular ejection fraction, hemoglobin, hematocrit, platelet count, autotransfusion, time of deep hypothermic circulatory arrest and time of extracorporeal bypass. The differences of age, hypertension and extracorporeal bypass time between the two groups were statistically significant(P=0.037, 0.029 and < 0.001), while the differences of other clinical indicators between the two groups were not statistically significant(P>0.05). Multivariate logistic regression analysis showed that hypertension and extracorporeal bypass time were the main influencing factors of intraoperative RBC transfusion volume in patients with Stanford type A aortic dissection(P= 0.021 and < 0.001, respectively). The postoperative complications, postoperative RBC transfusion volume, ICU hospitalization days, total hospitalization days and hospital death were compared between the two groups. The postoperative RBC transfusion volume and ICU hospitalization days in the group with intraoperative RBC transfusion ≤ 4 U were significantly less than those in the group with intraoperative RBC transfusion > 4 U( P=0.032 and 0.001 respectively).Conclusion Hypertension can reduce the risk of intraoperative RBC transfusion, and longer extracorporeal bypass time will increase the risk of intraoperative RBC transfusion during Stanford type A aortic dissection surgery. A larger amount of intraoperative RBC transfusion during surgery may lead to longer hospital stay in ICU.
作者
史景莉
马会敏
朱小影
蒋姝婷
刘鸿雁
燕备战
SHI Jing-li;MA Hui-min;ZHU Xiao-ying;JIANG Shu-ting;LIU Hong-yan;YAN Bei-zhan(Department of Blood Transfusion,Henan Provincial People's Hospital,Henan University People's Hospital,Zhengzhou University People's Hospital,Zhengzhou 450003,China)
出处
《医药论坛杂志》
2020年第10期95-98,共4页
Journal of Medical Forum
关键词
主动脉夹层
孙氏手术
红细胞
Aortic dissection
Sun’s operation
Red blood cell
