体外循环冠状动脉旁路移植术患者围术期输血情况及影响因素评估

Evaluation on the blood transfusion and influencing factors in patients with coronary artery bypass grafting

目的了解体外循环冠状动脉旁路移植术（on-pump CABG）患者围术期红细胞（RBC）、血小板（PLT）和新鲜冰冻血浆（FFP）的输注情况及其影响因素,为此类患者临床合理用血提供一定实验依据。方法 on-pump CABG患者291例,根据患者输注RBC和FFP量的不同,将患者分为未输注RBC/FFP组、输注量RBC/FFP小于3U组、3~6U组和大于6U组;根据患者输注PLT量的不同,将患者分为：未输注PLT组、输注PLT 1U组和大于1U组,用以观察患者输血概况及性别,年龄和血液流变学资料分布情况。采用多重线性回归方程分析影响on-pump CABG患者围术期RBC、PLT和FFP输注量的影响因素,选入的变量包括年龄、性别、体质量、吸烟、糖尿病、高血压、中风、陈旧性心梗、心功能分级、〉70%左主干狭窄、急性心肌梗死、冠状动脉支架术后、术前PLT、术前血红蛋白（Hb）、术前凝血酶原时间（PT）、术前活化部分凝血酶时间（APTT）、主动脉颊闭时间和体外循环时间。结果围术期输注RBC量的影响因素包括年龄、性别、急性心肌梗死、术前Hb水平和体外循环时间;FFP输注量的影响因素主要有急性心肌梗死、术前Hb水平和主动脉夹闭时间;PLT输注量的影响因素主要包括心功能分级、术前PLT计数、术前Hb水平和主动脉夹闭时间。结论 On-pump CABG患者围术期输血量是多因素作用的结果,可通过用血量评估为临床申请提供一定参考。

Objective To understand the influence factors of red blood cell （RBC） ,fresh frozen plasma（FFP） and platelet（PLT） transfusion of on-pump coronary artery bypass grafting（CABG） patients, and provide experiment basis for clinical blood transfu- sion. Methods A total of 291 on-pump CABG patients were collected,and divided into 4 groups （no RBC/FFP transfusion group, transfused RBC/FFP〈3 U group,3-6 U group,〉6 U group） according to the RBC and FFP volume they were transfused. Ac- cording to the PLT volume they were transfused, they were divided into no PLT transfusion group,transfused PLT 1 U group and more than 1 U group. Age,gender and blood theology variables in these groups were analyzed. Multiple linear regression were used tO get the influence factors of RBC,PLT and FFP transfusion volume, the selected variable were age,gender, weight, smoke, diabe- tes, hypertension, stroke, old myocardial infraction, the New York Heart Association （NYHA） functional classification, 〉 70 % left main coronary artery, acute myocardial infarction（ AMI）, after coronary stenting, preoperative PLT, hemoglobin （ Hb）, prothrombin time （PT）, activated partial thromboplastin time （APTT）, aortic buccal closing time and the time of cardiopulmonary bypass （CPB）. Results The influence factors of RBC transfusion including：age,gender, AMI, preoperative Hb and CPB time. Conclusion Perioperative blood transfusion amount in On-pump CABG patients could be the result of many factors.