后路脊柱手术隐性失血的预测

doi:10.24920/003463

摘要/Abstract

摘要：

目的确定隐性失血的危险因素可以揭示其可能的发生原因并为更合理的临床决策提供依据。本研究旨在确定脊柱手术隐性失血的预测因素。

方法回顾性地检索进行后路胸腰椎融合手术或脊柱侧弯手术患者的临床资料。记录人口统计学信息,围手术期可见失血量以及实验室检查结果。将接受融合手术或脊柱侧凸手术的患者分别分为隐性失血阳性亚组和隐性失血阴性亚组。然后分析各组之间变量的差异。采用二元Logistic回归分析确定与隐性失血相关的独立危险因素。

结果对于接受脊柱后路手术的患者,隐性失血相关的独立危险因素为自体输血(融合手术 P= 0.011,OR:2.627,95％CI:1.574~2.782；脊柱侧弯手术 P< 0.001,OR:2.268,95％CI:2.143~2.504)和同种异体输血(融合手术 P<0.001,OR:6.487,95％CI:2.349~17.915；脊柱侧凸手术P <0.001,OR:3.636,95％CI:2.389~5.231)。

结论术中输血可能是围手术期隐性失血的早期预警指标。

关键词: 脊柱手术, 隐性失血, 输血, 预测

Abstract:

Objective Identification of the risk factors for extraordinary hidden blood loss (HBL) could clarify the underlying causes and provide more appropriate management. This study aims to identify the predictors of HBL in spinal surgery.

Methods Medical records were retrospectively retrieved to collect the data of patients who undergoing posterior thoracic and lumbar fusion surgery or scoliosis surgery. Demographic information, perioperative visible blood loss volume, as well as laboratory results were recorded. The patients receiving fusion surgery or scoliosis surgery were further divided into the HBL positive subgroup and the HBL negative subgroup. Differences in the variables between the groups were then analyzed. Binary logistic regression analysis was performed to determine independent risk factors associated with HBL.

Results For patients undergoing posterior spinal surgery, the independent risk factors associated with HBL were autologous transfusion (for fusion surgery P=0.011, OR: 2.627, 95%CI: 1.574-2.782; for scoliosis surgery P<0.001, OR: 2.268, 95%CI: 2.143-2.504) and allogeneic transfusion (for fusion surgeryP<0.001, OR:6.487, 95%CI: 2.349-17.915; for scoliosis surgery P<0.001, OR: 3.636, 95%CI: 2.389-5.231).

Conclusion Intraoperative blood transfusion might be an early-warning indicator for perioperative HBL.

Key words: spinal surgery, hidden blood loss, transfusion, prediction

Bai Bing, Tian Yuan, Zhang Yuelun, Ma Manjiao, Yu Xuerong, Huang Yuguang. Prediction of Hidden Blood Loss During Posterior Spinal Surgery[J].Chinese Medical Sciences Journal, 2019, 34(1): 38-44.

图/表 5

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Variables	Thoracolumbar spine fusion surgery (n=292)	Scoliosis surgery (n=269)	Statistic	P-value
Male [n (%)]	132 (45.2)	100 (37.2)	3.39	0.06
Female [n (%)]	160 (54.8)	169 (62.8)	3.39	0.06
Age^§ (yrs)	54.6±15.6	15.6±9.1	35.77	0.00
Height^§ (m)	1.64±0.11	1.49±0.18	12.01	0.00
Weight^§ (kg)	68.9±13.4	44.1±14.3	21.19	0.00
Body mass index^§(kg/m²)	25.4±3.8	19.1±3.5	20.37	0.00
Surgical duration (min)	174.2±55.0	213.6±80.1	-6.83	0.00
Autologous blood transfusion [n (%)]	105 (35.9)	164 (60.9)	34.08	0.00
Allogeneic blood transfusion [n (%)]	24 (8.2)	66 (24.5)	26.47	0.00

Variables	Hidden blood loss positive (n=118)	Hidden blood loss negative (n=174)	P-value
Gender			0.490
Male [n (%)]	40 (33.9)	73 (41.9)
Female [n (%)]	78 (65.5)	101 (58.0)
Age^§ (yr)	56.3±14.1	51.8±16.3	0.015
Height^§ (m)	1.58±0.09	1.68±0.11	<0.001
Weight^§ (kg)	64.6±11.7	71.6±13.8	<0.001
Body mass index^§ (kg/m²)	25.6±3.9	25.2±3.7	0.328
Number of segments^§	2.27±1.89	1.86±1.05	0.026
Surgical duration^§ (min)	182.2±61.5	168.4±49.6	0.036
Visible blood loss^§ (ml)	797.5±692.3	775.2±601.6	0.688
Intraoperative infusion of crystalloids^§ (ml)	1518.3±998.2	1514.9±907.6	0.657
Intraoperative infusion of colloids [ml, M (QR) )]	500 (500, 1000)	500 (500, 1000)	0.135
Intraoperative autologous blood transfusion [n (%)]
Yes	73 (61.8)	40 (23.0)	<0.001
No	45 (38.2)	134 (77.0)
Intraoperative allogeneic blood transfusion [n (%)]
Yes	19 (16.2)	5 (2.9)	<0.001
No	99 (83.8)	169 (97.1)
Intraoperative frozen plasma infusion [n (%)]
Yes	8 (6.7)	4 (2.3)	0.074
No	110 (93.3)	170 (97.7)

Variables	β	SE	P	OR	95%CI
Age>60 yrs	0.448	0.840	0.594	1.564	0.302-8.111
Height<1.60 m	0.321	0.508	0.527	1.379	0.509-3.731
Weight<65 kg	-0.019	0.383	0.961	0.981	0.463-2.080
Number of segments>2	0.253	0.356	0.477	0.477	0.386-1.559
Surgical duration>180 min	0.286	0.299	0.338	0.751	0.418-1.349
Autologous blood transfusion	2.019	0.537	0.011	2.627	1.574-2.782
Allogeneic blood transfusion	1.870	0.518	<0.001	6.487	2.349-17.915

Variables	Hidden blood loss positive (n=100)	Hidden blood loss negative (n=169)	P-value
Gender			0.888
Male [n (%)]	37 (37.0)	60 (35.5)
Female [n (%)]	63 (63.0)	109 (64.5)
Age^§ (yr)	17.6±9.9	16.4±8.6	0.272
Corrected height^§ (m)	1.53±0.19	1.52±0.18	0.826
Weight^§ (kg)	43.6±13.9	44.2±14.6	0.718
Body mass index^§ (kg/m²)	19.0±3.55	19.1±3.51	0.819
Number of segments^§	9.9±3.8	9.0±3.5	0.120
Osteotomy [n (%)]
Yes	41 (41.0)	44 (26.0)	0.011
No	59 (59.0)	125 (73.9)
Preoperative Cobb angle^§ (°)	66.23±26.7	58.65±23.1	0.022
Operation duration^§ (min)	254.6±72.6	217.9±81.6	<0.001
Visible blood loss^§ (ml)	1336±947.1	1175±811.2	0.131
Intraoperative infusion of crystalloids^§ (ml)	1524.8±892.2	1480.2±728.2	0.566
Intraoperative infusion of colloids (ml)	1000 (500, 1000)	500 (500, 1000)	0.004
Intraoperative autologous blood transfusion [n (%)]
Yes	93 (93)	121 (71.6)	<0.001
No	7 (7.0)	48 (28.4)
Intraoperative allogeneic blood transfusion [n (%)]
Yes	50 (50.0)	11 (6.5)	<0.001
No	50 (50.0)	158 (93.5)
Intraoperative frozen plasma infusion [n (%)]
Yes	36 (36.0)	13 (7.7)	<0.001
No	64 (64.0)	156 (92.3)

Variables	β	SE	P	OR	95%CI
Osteotomy	0.035	0.258	0.819	1.036	0.625-1.716
Preoperative Cobb angle>60°	0.378	0.306	0.217	1.460	0.801-2.661
Operation duration>240 min	0.446	0.283	0.115	0.640	0.368-1.114
Colloids infusion>800 ml	1.102	0.240	0.536	1.233	0.636-2.389
Autologous blood transfusion	0.121	0.361	<0.001	2.268	2.143-2.504
Allogeneic blood transfusion	0.209	0.338	<0.001	3.636	2.389-5.231
Frozen plasma	-1.315	0.321	0.051	0.268	0.143-0.504

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