肝移植术患者术中大量输血的危险因素分析

Analysis of risk factors for intraoperative massive blood transfusion in patients undergoing liver transplantation

目的通过对肝移植受体大样本资料的回顾分析,寻找与围术期大量输血有关的危险因素,建立适合国内患者的风险模型。方法回顾性分析北京大学人民医院2004年7月至2009年2月的263例肝移植受体的临床资料。以术中红细胞输入量是否≥12U将患者分为两组,比较两组患者术前变量的差异,并对其与术中大量输血之间的关系进行Logistic回归分析。结果既往上腹部手术史、大量腹水、血清总胆红素、血小板计数(Plt)和红细胞压积(Hct)与术中大量输血存在相关性(P<0.10)。成人终末期肝病(ELSD)肝移植术中大量输血发生的预测模型(PSMT)为y=2.591+1.484×上腹部手术史+0.457×大量腹水+0.002×血清总胆红素值-0.004×Plt-0.058×Hct。结论既往有上腹部手术史、腹水≥20ml/kg、血清总胆红素升高、Plt和Hct降低是引起术中大量输血的危险因素。

Objective By a large scale review of liver transplantation candidates, the purpose of this study is to find the risk factors associated with perioperative massive blood transfusion, try to build a appropriate risk model for our patients. Methods Meta analysis of clinical data on 263 liver transplantation candidates admitted in our hospital from July 2004 to February 2009. The patients were divided into two groups according to whether the amount of intraoperative total red blood cell transfusion ≥12U. Compare the differences of preoperative parameters in two groups and make a Logistic regression analysis of the relationship between these parameters and intraoperative massive transfusion. Results Prior history of upper abdominal operations, massive aseites, serum total bilirubin, platelet count and hematocrit are related to intraoperative massive blood transfusion according to Logistic regression analysis （P 〈 0.10）. Preoperative score of massive transfusion （PSMT） in adult end-stage liver disease（ELSD） liver transplation is y= 2. 591＋1. 484 × prior history of upper abdominal operations＋ 0. 457 × massive ascites ＋ 0. 002 × serum total hilirubin - 0. 004 × PLT-0. 0585〈 hematocrit. Conclusion Prior history of upper abdominal operations, massive ascite≥ 20 ml/kg, increased serum total bilirubin and decreased platelet count and hematocrit are the risk factors for intraoperative massive blood transfusion.