体外循环冠脉搭桥患者围术期输红细胞量的评估及其对术后肺部并发症的影响分析

Assessment of RBC Transfusion Volume and Its Effect on Postoperative Pulmonary Complications in On-pump CABG Patients

本研究旨在明确围术期红细胞输注量对体外循环冠脉搭桥患者术后肺部并发症的影响并对输红细胞量的影响因素进行评估。根据红细胞输注量不同,将292名患者分为未输红细胞组(n=71)、输1-4 U红细胞组(n=144)和输>4 U红细胞组(n=77)。用逐步增加变量的多元logistic回归方法分析围术期红细胞输注量与术后肺部并发症的关系;用多元线性回归方法分析围术期红细胞输注量的影响因素。结果发现:3组比较,术后肺部并发症的发生率有显著差异(1.4%vs 14.6%vs 24.7%,P<0.001);红细胞输注量以逐级递增的趋势体现其与肺部并发症的相关性,OR值从回归分析模型1中1.205到模型2中1.241,直到模型3中的1.251(95%CI:1.120-1.398,P<0.001);多元线性分析影响红细胞输注量的因素包括:年龄(B:0.102;95%CI:0.046-0.157,P<0.001)、性别(B:1.825;95%CI:0.692-2.957,P=0.002)、术前Hct(B:-36.044;95%CI:-47.724--25.163,P<0.001)、体外循环时间(B:0.031;95%CI:0.013-0.050,P=0.001)和急性心肌梗塞(B:2.769;95%CI:1.295-4.243,P<0.001)。结论:体外循环冠脉搭桥患者术后肺部并发症的发生与围术期红细胞输注量显著相关,影响围术期红细胞输注量的因素主要有:术前HCT、年龄、急性心肌梗塞、性别和体外循环时间。

This study was purposed to investigate the effect of the transfused RBC amount on pulmonary complications after on-pump CABG surgery,and to explore the influencing factors on RBC transfusion volume.292 adult patients receiving on-pump CABG surgery were divided into non-RBC transfusion group （n =71）,1-4 U RBC transfusion group （n =144） and ＞4 U RBC transfusion group （n =77）.Adjusted multivariable regression analysis was performed to examine the correlation between transfused RBC amount and the odds of pulmonary complications,and multivariable linear regression was used to analyze the influencing factors on RBC transfusion volume.The results showed that compared the three groups,there was the significant difference in postoperative pulmonary complications （1.4％ vs 14.6％ vs 24.7％,P ＜0.001）.A stronger and graded correlation was found between transfused RBC amount and pulmonary complications in on-pump CABG patients,the adjusted odds were increased to 1.251 （95％ CI：1.120-1.398,P ＜0.001）,and influencing factors on RBC transfusion volume were as follows：age （B：0.102 ; 95 ％ CI：0.046-0.157,P ＜ 0.001）,sex （B：1.825 ; 95 ％ CI：0.692-2.957,P =0.002）,preoperative Hct （B：-36.044; 95 ％ CI：-47.724--25.163,P＜0.001）,CPB time （B：0.031; 95％ CI：0.013-0.050,P=0.001） and acute myocardiac infarction （B：2.769; 95％ CI：1.295-4.243,P ＜ 0.001）.It is concluded that the transfused RBC amount is related with postoperative pulmonary complications,and the influencing factors on RBC transfusion volume include preoperative Hct,age,acute myocardiac infarction,sex and CPB time.