输血与体外循环下小儿先天性心脏病术后肺损伤相关性研究

Retrospective cohort analysis of associations between blood transfusion and postoperative lung injury after cardiac surgery

目的分析先天性心脏病患儿围术期输血与术后肺损伤的相关性。方法对浙江大学医学院附属儿童医院2010年1～9月收治行体外循环下手术矫治的先天性心脏病患儿492例进行回顾性分析，比较围术期输血量与输血浆量、手术方法、年龄、体外循环时间、主动脉阻断时间、术中患儿最低温度和最低红细胞压积（Hct）对术后肺损伤的影响。结果用阿里斯多德评分对患儿手术复杂程度进行分层；围术期输血或血浆量越多，术后肺损伤发病率越高（P〈0．001）；多因素logistic回归分析，结果显示围术期输血量，围术期输血浆量，术中最低Hct〉30％（OR=2．76），年龄≤1岁（OR=5．10），CPB时间〉80min（OR=2．58）是发生术后肺损伤的独立危险因素；手术复杂程度（阿里斯多德评分）越高，术后肺损伤的发生越加明显（分层3比分层1，P〈0．05；分层4比分层1，P〈0．01）。术后肺损伤组有更长的术后呼吸机辅助时间和ICU停留时间（P值均〈0．001）。术前贫血的患儿围术期输血量[（75．31±2．18）ml／kg，n=284]明显多于没有贫血患儿的输血量E（53．59±2．87）ml／kg，n=208]，P〈0．001。结论围术期输血、血浆与先心术后肺损伤密切相关；输血、血浆量越多，肺损伤发生的风险越高，建议开展多种节约用血措施包括纠正术前贫血。

Objective To explore the associations between blood transfusion and postoperative lung injury after pediatric cardiac surgery. Methods Retrospective reviews were conducted for 492 consecutive children with congenital heart disease （CHD） undergoing cardiopulmonary bypass （CPB）. And the associations were analyzed between transfusion of red blood cell （RBC） and plasma, operative approach, age, CPB duration, aortic artery blocking time, lowest temperature, lowest intraoperative hemoglobin （Hct） and morbidity of postoperative lunginjury. Results Their demographics were assessed by the Aristotle Basic Complexity （ABC） propensity score. More morbidity of postoperative lung injury was found in patients with more transfusion of RBC b- plasma （P^0. 001）. Multivariate analysis showed that more transfusion of RBC b- plasma, lowest Hct ~30~ （OR= 2.76）, aged 1 year （OR= 5. 10） and CPB duration ~80 min （OR = 2.58） were the independent risk factors of postoperative lung injury. More complex surgery had a higher rate of lung injury （ABC level 3 vs 1, P^0. 053 ABC level 4 vs 1, P^0.01 ）. The patients with postoperative lung injury had also longer mechanical ventilation duration and intensive care unit （ICU） stay length （P^0. 001 ）. The voulme of perioperative blood transfusion in children with preoperative anemia （n = 284） was significantly more than that in those without preoperative anemia （n = 208） （75.31 ＋ 2.18 vs 53.59 ＋ 2.87 ml/kg, P~ 0. 001）. Conclusions Transfusion of RBC ~ plasma is closely correlated with postoperative lung injury. The more transfusion, the higher risk of postoperative lung injury. And a variety of blood