输注新鲜或库存红细胞悬液对患者术后影响的临床研究

Clinical Research on the Effect of Infusing Fresh or Old Red Cell Suspension on Patients' Postoperative Prognosis and Outcome

目的：评价输注新鲜或库存红细胞悬液及不同输血量对手术患者预后影响的临床研究。方法观察分析新疆医科大学第一附属医院2013年1-12月间273例择期首次行骨科手术的患者。纳入标准：年龄15-65岁，BMI 18-25kg／m^2，性别种族不限，ASA分级Ⅰ-Ⅱ级，围术期出血量大于全身血容量的20％、需输注红细胞悬液≤10U、根据围术期输注红细胞储存天数，分为新鲜组（储存天数≤14天）和库存组（储存天数＞14天），并根据输血量分为≤2单位（U）、3-4U、≥5U 3组。记录患者人口学基本资料及术中出血量、术后24h血红蛋白等，并比较两组患者住院时间、ICU转入率、肺部感染发生比、术后再次输红细胞率、切口愈合状况、心血管不良事件的发生率等预后指标。结果两组患者人口学基本资料、手术一般情况、住院时间、ICU转入率、切口愈合状况、血浆D－二聚体浓度差异无统计学意义（P＞0．05）；术后24h血红蛋白、术后再输红细胞率、术后肺部感染发生比、心血管不良事件发生率的差异有统计学意义（P＜0．05）；且输血量越多，患者术后并发症发生率越高。结论输注储存时间较长的红细胞对重大手术患者术后并发症有一定影响，且输血量与患者术后并发症存在关联。

Objective To evaluate the effect of infusion of fresh or old red cell suspension and different volume of blood transfusion on the prognosis of patients with surgical.Methods Totally 273 patients undergoing the first elective orthopedic surgery from the first af-filiated hospital of Xinjiang medical university from January 2013 to December were enroued.Accepting criteria induded 15-65years ,no limitation for race and gender, ASAⅠ-Ⅲgrade, need of transfusion of red blood cell≤10U.According to the oldest storage age of any RBCs transfused：patients who received only RBCs stored for≤14 days were grouped to the Fresh, those who only RBCs stored for 〉14 days were grouped to the Old.According to the volume of blood transfusion were divided into ≤2U, 3 -4U, ≥5U three groups. Record The demographic and clinical features of the patients were recorded and length hospital stay, the rate of ICU shift, pulmonary in-fection occurred, postoperative transfusion rate, incision healing condition and major adverse cardiovascular events of to compared two groups.Results There was statistical differences in postoperative 24h hemoglobin , postoperative transfusion rate, pulmonary infection occurred and major adverse cardiovascular events between the Fresh and Old group （ P〈0.05） .A trend of increasing complication rate was observed with more units transfused, especially≥5U.Conclusion Infusion of old red cell suspension has a certain impact on the surgery patients′postoperative complications.The volume of blood transfusion is consistently associated with adverse outcome.