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术中自体血回输患者异体输血合理性的回顾性分析
- Affiliations：
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,中国
- Author bio：
* Tel:86-10-69152020; E-mail: yuxuerong@pumch.cn.
- Funds：
DOI：10.24920/11807
中图分类号：收稿日期：2017-09-25，
网络出版日期：2018-06-20，
纸质出版日期：2018-06-20
- Accepted：
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马满姣, 虞雪融, 汪一, 等. 术中自体血回输患者异体输血合理性的回顾性分析[J]. Chinese Medical Sciences Journal, 2018,33(2):77-83.
Ma Manjiao, Yu Xuerong, Wang Yi, et al. 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.
马满姣, 虞雪融, 汪一, 等. 术中自体血回输患者异体输血合理性的回顾性分析[J]. Chinese Medical Sciences Journal, 2018,33(2):77-83. DOI： 10.24920/11807.
Ma Manjiao, Yu Xuerong, Wang Yi, et al. 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. DOI： 10.24920/11807.
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。
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.
关键词
Keywords
references
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