以自体输血为主的整体省血策略在二尖瓣置换术中的应用效果

Intraoperative autologous based blood conservation strategies in mitral valve replacement

目的探讨以自体输血为主的整体省血策略减少二尖瓣置换术围手术期异体血液制品输注的效果。方法回顾性分析2008年1月至2013年12月在浙江大学医学院附属第一医院心胸外科接受二尖瓣置换术的835例患者的临床资料，其中2008年1月至2010年12月收治的517例患者未进行自体输血（非自体组），2011年1月至2013年12月收治的318例患者进行自体输血（自体组）。自体输血组采用积极的整体省血策略，包括统一的术中自体输血公式、严格的术中术后异体输血标准及激进的小预充液体积。采用t检验和χ^2检验比较两组术中心肺转流参数、术后并发症、术中术后输血及术后出院时间、血细胞比容等，对术中术后输注异体浓缩红细胞的影响因素进行多元逻辑回归分析。结果两组术前临床资料具有可比性。两组术中心肺转流阻断时间和转流时间相似。自体组术中和术后异体输血例数[55例（17．0％）比215例（42．1％），χ^2=53．0，P=0．000]、胸腔引流量[150（380）ml比700（660）ml，H=195．648，P=0．000]和住院时间[（16±6）d比（20±8）d，t=9．60，P=0．000]均低于非自体组。自体组术后和出院时血细胞比容相对较低（30％±5％比33％±4％，t=7．76，P=0．000；30％±4％比32％±5％，t=3．86，P=0．000）。多元逻辑回归分析结果表明，年龄（OR=1．21，P=0．022）、自体输血与否（OR=0．28，P=0．000）及吸烟史（OR=0．62，P=0．049）是术后输血率的危险因素。结论在二尖瓣置换术中采用以自体输血为主的整体省血策略，能有效减少术中术后异体血液制品输注，减少患者的术后并发症。

Objective To evaluate whether intraoperative autologous donation （IAD） can reduce perioperative blood transfusion for patients underwent mitral valve replacement （MVR）. Methods A total of 318 patients received implementation of IAD from January 2011 to December 2013 were analyzed retrospectively, and compared with 517 patients of the previous 36-month period （from January 2008 to December 2012）. The method of small-volume retrograde autologous priming, strict blood transfusion standard along with IAD together constituted a progressive blood-saving strategy. Statistical methods including Students＇ t-test, Pearson＇s χ^2 test, Kruskal-Wallis analysis and multivariate Logistic regression model were used for comparisons of the data. Results There were no significant difference between IAD group and non-lAD group considering preoperative patient demographics, characteristics and preoperative comorbidities. However, IAD group significantly reduced number of patients transfused with intra/postoperative packed red-blood cell （PRBC） （55（17.0%） vs. 315 （42. 1% ）, χ^2 = 53. 0, P = 0. 000）, and had significantly reduced postoperative chest tube output （150（380） ml vs. 700（660） ml, H = 195. 648, P = 0. 000）, length of stay （ （ 16 ± 6） d vs. （20 ± 8） d, t = 9. 60, P = 0. 000）. But hematocrit were lower in IAD group （30% ±5% vs. 33% ±4% at end of operation, t =7.76, P=0. 000; 30% ±4% vs. 32% ± 5% at discharge, P = 0. 000, t = 3.86）. Multivariate logistic aggression analysis revealed that age, IAD and smoking history were factors influencing the probability of intra or postoperative blood transfusion. Conclusion Implementation of blood conservation strategies based on intraoperative autologous donation in mitral valve replacement surgery can significantly reduce intra/＇postoperative blood transfusion as well as postoperative complications.