术中自体血回输患者异体输血合理性的回顾性分析

doi:10.24920/11807

摘要/Abstract

摘要：

目的尽管术中自体血回输已经广泛用于减少异体血输血的用量,但是使用自体血回输的患者并没有完全能够避免异体血输血。本研究旨在了解术中自体血回输患者异体红细胞的输注率及其合理性,并探讨此类患者不合理输注异体红细胞的危险因素。方法回顾性收集2013年1月至2014年7月期间术中使用自体血回输患者的临床资料。估算每个患者输注回收自体红细胞后手术结束时的理论血红蛋白水平,当患者理论血红蛋白大于100g/L并接受异体红细胞输注的情况定义为不合理输血。比较不合理输血患者与其他患者在手术科室、性别、年龄、体重、失血量/估计血容量(EBV)、自体血回输量和术前血红蛋白水平等临床指标的分布差异,采用logistic回归分析识别此类不合理输血的危险因素。结果本研究共搜集到1487例术中使用自体血回输的患者,其中术中接受异体红细胞输血的输注率为31.4%（467/1478）,理论血红蛋白水平>100g/L而接受异体红细胞输血所构成的不合理输注率为26%（341/1313）。与没有接受异体红细胞输注的患者相比,接受不合理异体红细胞输注的患者年龄偏小（t = 4.656, P < 0.001）、体重较轻（t = 3.910, P < 0.001）、术前血红蛋白水平较低（t = 2.822, P = 0.005）,自体血回输量偏多（U = -10.926, P < 0.001）,以及出血量与估计血容量（EBV）的比值偏大（U =-17.067,P < 0.001）,而与患者术前有无贫血（HGB男性<120g/L,女性<110g/L）无关（U =-1.396, P = 0.163）。Logistic回归分析显示,术前血红蛋白水平(OR =1.975, P = 0.005) 和出血量／估计血容量比值(OR = 5.392, P < 0.001)是导致此类不合理输注的独立危险因素。结论采用术中自体血回输患者存在不合理异体红细胞输注现象;不合理输血可能与患者术前血红蛋白水平和出血量/估计血容量比值有关。需要在输血前测定血红蛋白水平以避免不必要的输血。医生应更新血液管理和合理用血的认知以改善患者的医疗质量。

关键词: 术中自体血回输, 合理用血, 患者血液管理, 术前贫血

Abstract:

Objective Although intraoperative cell salvage (ICS) has been widely used to reduce the demand for allogeneic blood transfusion, patients who use ICS approach still have not completely avoided chances of blood transfusion. This study aims to investigate the rate of allogeneic red blood cell(RBC) transfusion in patients receiving ICS, and to evaluate irrationality of allogeneic RBC transfusion and its risk factors.Methods Medical records of all patients associated with ICS approach from January 2013 to July 2014 were retrospectively reviewed. Theoretical hemoglobin level after reinfusion of salvaged RBC at the end of operations was estimated. Irrational transfusion was defined as initiating allogeneic transfusion with theoretical hemoglobin above 100 g/L. The clinical variables, including the surgical department, gender, age, body weight, ratio of blood loss to estimated blood volume(EBV), salvaged blood volume and preoperative hemoglobin level were subsequently compared between patients who received rational transfusion and those did not. Logistic regression was performed to identify the risk factors for irrationality of allogeneic RBC transfusion in these patients.Results Of 1487 patients with ICS approach in this study, the rate of allogeneic RBC transfusion was 31.4%(467/1487), and the rate of irrational allogeneic RBC transfusion was 26.0% (341/1313). Patients with irrational transfusion were younger (t=4.656, P<0.001), with lower body weight (t=3.910, P<0.001) and slightly lower preoperative HGB level (t=2.822, P=0.005) than those with rational transfusion, but had significantly larger salvaged blood volume (U=-10.926, P<0.001) and higher ratio of blood loss to EBV (U=-17.067, P<0.001), disregarding whether they preoperatively met anemia criteria or not (U=-1.396, P=0.163). Preoperative hemoglobin level (OR=1.975, P=0.005) and the ratio of blood loss/EBV (OR=5.392, P<0.001) were independent risk factors leading to the irrational allogeneic RBC transfusion.Conclusions The irrationality of allogeneic RBC transfusion existed in ICS patients, which may be associated with the preoperative hemoglobin level and the ratio of blood loss to EBV. Determining the HGB levels before transfusion is required to avoid unnecessary blood administration. Doctors should keep their knowledge in blood management updated and improve their awareness of rational transfusion for a better patients care.

Key words: intraoperative cell salvage, rational transfusion, patient blood management, preoperative anemia

Ma Manjiao, Yu Xuerong, Wang Yi, Huang Yuguang, Lu Sufang, Tian Yuan, Bai Bing. Irrationality of Allogeneic Red Blood Cell Transfusion in Intraoperative Cell Salvage Patients: a Retrospective Analysis[J].Chinese Medical Sciences Journal, 2018, 33(2): 77-83.

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Characteristics	Non-transfusion (n=1020)	Transfusion (n=467)	t or Uvalue	P value
Surgical department, n (%)			-0.836	0.178
Orthopedics	715(70.1)	356(76.2)
Neurosurgery	146(14.3)	25(5.4)
Vascular	62(6.1)	36(7.7)
Obstetrics and gynecology	52(5.1)	3(0.6)
Hepatic	29(2.8)	11(2.4)
General	10(1.0)	19(4.1)
Urology	6(0.6)	11(2.4)
Thoracic	0(0)	3(0.6)
Stomatology	0(0)	2(0.4)
Otorhinolaryngology	0(0)	1(0.2)
Gender, n (%)			-1.674	0.094
Male	403(39.5)	206(44.1)
Female	617(60.5)	261(55.9)
Age, years	43.1±21.5	37.6±22.3	4.528	<0.001
Body weight, kg	62.9±15.9	57.8±19.6	4.944	<0.001
Preoperative HGB, g/L	136.7±16.6	127.8±22.8	7.571	<0.001
Blood loss, mL	579.1±348.00	1323.6±1178.2	-13.389	<0.001
Blood loss /EBV, %	12.1±7.7	30.3±27.0	-14.345	<0.001
Salvaged blood volume, mL	291.5±174.6	553.0±445.3	-12.266	<0.001

Clinical characteristics	Theoretical HGB >100g/L		t or U value	P value
Clinical characteristics	Non-transfusion (n=972)	Transfusion (n=341)	t or U value	P value
Gender, n (%)			-0.614	0.539
Male	392(40.3)	144(42.2)
Female	580(59.7)	197(57.8)
Age, years	43.2±21.7	36.8±22.5	4.656	<0.001
Body weight, Kg	63.2±16.0	58.3±20.8	3.910	<0.001
Blood loss/EBV, %	11.7±6.6	22.8±11.4	-17.067	<0.001
Salvaged blood volume, mL	288.0±164.2	499.9±344.7	-10.926	<0.001
Preoperative HGB, g/L	138.5±13.9	136.1±13.6	2.822	0.005
Age, n (%)			-3.488	<0.001
<14yrs	109(11.2)	66(19.4)
14≤age<65yrs	676(69.5)	224(65.7)
≥65yrs	187(19.2)	51(15.0)
Preoperative anemia, n (%)			-1.396	0.163
No	896(92.2)	306(89.7)
Yes	76(7.8)	35(10.3)
Blood loss/EBV, n (%)			-17.646	<0.001
<20%	873(89.8)	150(44.0)
20%-49%	98(10.1)	178(52.2)
≥50%	1(0.1)	13(3.8)

Variables	β	SE	Wald	P	OR	95% CI
Salvaged blood volume	0.002	0.000	21.079	<0.001	1.002	1.001-1.003
Body weight	-0.011	0.005	3.921	0.048	0.989	0.979-1.000
Preoperative HGB	0.680	0.243	7.818	0.005	1.975	1.226-3.182
Blood loss/EBV	1.685	0.210	64.277	<0.001	5.392	3.571-8.139
Age	-0.046	0.148	0.096	0.757	0.955	0.714-1.277

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