妇科围术期输血现状及特点

Current Status and Characteristics of Perioperative Transfusion in Gynecologic Patients

目的分析妇科围术期输血的现状及特点,总结合理用血措施。方法回顾性分析2014年1月至10月在北京协和医院行妇科手术的病例,统计其中围术期输血病例,分析不同疾病、不同手术方式的输血情况及特点。2013年同期妇科手术和输血病例作为对照进行比较。结果 2014年1月至10月妇科手术总量6203例,其中围术期异体输血286例,自体输血80例,妇科手术异体输血率4.6%,手术总量较2013年同期增加10.5%,而输血率降低27.0%(P=0.001)。恶性肿瘤手术具有较高的输血率,其中输血率最高的是卵巢癌肿瘤细胞减灭术及再次肿瘤细胞减灭术,输血率达45.3%,输血病例的平均输血量达6.7 U。腹腔镜手术的输血率普遍低于开腹手术。腹腔镜宫颈癌根治术的输血率为6.2%,而开腹宫颈癌根治术则达到10.9%。自体输血主要用于宫外孕/黄体破裂内出血、子宫肌瘤/肌腺瘤剔除和开腹全子宫切除术,其自体输血率分别为17.0%、5.2%和2.8%,平均输血量分别为749、429和397 ml。结论 2014年较2013年同期妇科手术总量增加,但输血率下降,选择恰当的手术方式,积极开展微创手术,合理进行自体输血,是妇科围术期合理用血的主要措施。

Objective To analyze the current status and characteristics of perioperative transfusion in pa-tients undergoing gynecologic surgery and to explore the rational management of blood product use. Methods Clinical data of patients who underwent gynecologic surgery in Peking Union Medical College Hospital from Janu-ary to October in 2014 were retrospectively reviewed. Those who received perioperative transfusion were analyzed to summarize the status and characteristics of transfusion for different diseases and surgical procedures. The data of patients in 2014 were compared with those of patients in the corresponding period of 2013 . Results Altogeth-er 6203 patients underwent gynecologic surgery in Peking Union Medical College Hospital from January to October in 2014, including 286 patients who had allogeneic transfusion during perioperative period, and 80 who had au-tologous transfusion. The total number of surgery in 2014 increased by 10. 5% compared with the same period in 2013, while the allogeneic transfusion rate in 2014 （4. 6%） decreased by 27% compared with the same period in 2013 （ P=0. 001 ） . Operations for malignancies had higher transfusion rates than those for mild diseases.＆amp;nbsp;Cytoreductive surgery and re-cytoreductive surgery for ovarian cancer had the highest rate of transfusion （45. 3%） , and the average transfusion volume was 6. 7 U. Laparoscopy had lower transfusion rate compared with laparotomy. In radical resection of cervical cancer, approach by laparoscopy had a lower rate of transfusion than by laparotomy （6. 2% vs. 10. 9%） . Autologous transfusion was applied mainly in operations for ectopic pregnancy or internal bleeding due to rupture of corpus luteum, myomectomy and total hysterectomy, with autologous transfusion rates being 17. 0%, 5. 2%, and 2. 8%, and average transfusion volume being 749, 429, and 397 ml, respectively. Conclusions Perioperative transfusion rate in 2014 was lower than in 2013 despite more gynecologic operations in 2014 . Rational blood use in gynecologic patients can be managed by strategies including selection of appropri-ate surgery procedures, application of minimally invasive surgery, and proper use of autologous trasfusion.