Chinese Medical Sciences Journal ›› 2019, Vol. 34 ›› Issue (1): 38-44.doi: 10.24920/003463

• 论著 • 上一篇    下一篇

后路脊柱手术隐性失血的预测

白冰1,田园1,张越伦2,马满娇1,虞雪融1,*(),黄宇光1   

  1. 1 中国医学科学院 北京协和医学院,北京协和医院 麻醉科,北京100730
    2 中国医学科学院 北京协和医学院,北京协和医院 中心实验室,北京100730
  • 收稿日期:2018-05-15 修回日期:2019-02-22 出版日期:2019-03-30 发布日期:2019-04-08
  • 通讯作者: 虞雪融 E-mail:yuxuerong@pumch.cn

Prediction of Hidden Blood Loss During Posterior Spinal Surgery

Bai Bing1,Tian Yuan1,Zhang Yuelun2,Ma Manjiao1,Yu Xuerong1,*(),Huang Yuguang1   

  1. 1 Department of Anesthesiology,Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
    2 Central Research Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
  • Received:2018-05-15 Revised:2019-02-22 Published:2019-03-30 Online:2019-04-08
  • Contact: Yu Xuerong E-mail:yuxuerong@pumch.cn

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

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