围手术期血浆输注对肝切除术后并发症影响及其相关因素

Effects and correlative factors of perioperative fresh frozen plasma transfusion on complications after hepatectomy

目的探讨围手术期新鲜冰冻血浆(FFP)输注对肝切除术后并发症影响及其相关因素。方法回顾性分析2009年8月至2015年9月在西安交通大学第一附属医院行肝切除术的613例患者临床资料。根据围手术期有否输注FFP将患者分为FFP输注组(FFP组)和FFP未输注组(对照组)。其中FFP组383例,男303例,女80例;平均年龄(53.0±1.0)岁。对照组230例,男173例,女57例;年龄(53.0±1.0)岁。患者均签署知情同意书,符合医学伦理学规定。采用倾向得分匹配(PSM)法对两组患者进行匹配,术后并发症发生率比较采用χ~2检验或Fisher确切概率法,将患者临床参数纳入影响FFP输注的影响因素,相关因素分析采用Logistic回归。结果经过PSM之后共获得147对匹配患者,匹配后FFP组的术后总体并发症发生率为45.6%(67/147),明显高于对照组的33.3%(49/147)(χ~2=4.61,P<0.05)。其中FFP组的术后腹腔积液发生率为31.3%(46/147),明显高于对照组的15.6%(23/147)(χ~2=10.02,P<0.05)。Logistic回归分析显示,体重指数(BMI)≤18.50 kg/m^2、美国麻醉医师协会(ASA)分级Ⅲ~Ⅳ级、ALB≤40 g/L、Plt≤100×10~9/L、手术时间>180 min、术中出血量>500 ml、有第一肝门阻断、半肝及半肝以上切除均为围手术期FFP输注的独立影响因素(OR=3.14,2.01,1.76,1.65,1.85,3.16,1.62,1.68;P<0.05)。结论围手术期FFP输注可增加肝切除术后腹腔积液的发生率,消瘦、麻醉耐受力差、手术范围大、术中出血量多为决定患者FFP输注的关键因素。

Objective To investigate the effects and correlative factors of perioperative fresh frozen plasma （FFP） transfusion on complications after hepatectomy. Methods Clinical data of 613 patients who underwent hepatectomy in the First Affiliated Hospital of Xi＇an Jiaotong University between August 2009 and September 2015 were retrospectively analyzed. According to the patients received perioperative FFP transfusion or not, the patients were divided into the FFP transfusion group （FFP group, n=383） and non-FFP transfusion group （control group, n=230）. In the FFP group, 303 cases were males and 80 were females, aged （53.0±1.0） years old on average. In the control group, 173 cases were males and 57 were females, aged （53.0±1.0） years old on average. The informed consents of all patients were obtained and the local ethical committee approval was received. The patients were matched using propensity score matching （PSM） method, and the incidence of postoperative complications was compared using Chi-square test or Fisher＇s exact probability test. Clinical parameters of the patients were included as the influencing factors of FFP transfusion, and the correlation analysis was conducted using Logistic regression analysis. Results A total of 147 pairs of patients were matched using PSM method. After the patients were matched, the incidence of postoperative overall complications and peritoneal effusion in the FFP group was respectively 45.6% （67/147） and 31.3% （46/147）, signifantly higher than 33.3% （49/147） and 15.6% （23/147） in the control group （χ2=4.61, 10.02; P〈0.05）. Logistic regression analysis indicated that body weight index （BMI）≤ 18.50 kg/m2, American Society of Anesthesiologists （ASA） grading Ⅲ-Ⅳ, ALB ≤40 g/L, Pit ≤ 100 ×109/L, operation time 〉180 min, intraoperative blood loss 〉500 ml, the first hepatic portal occlusion, hemihepatectomy and major hepatectomy were the independent influencing factors of perioperative FFP transfusion （OR=3.14, 2.01, 1.76, 1.65, 1.85, 3.16, 1.62, 1.68;P〈0.05）. Conclusions Perioperative FFP transfusion can increase the incidence of peritoneal effusion after hepatectomy. Emaciation, poor tolerance to anesthesia, extensive surgical area and massive intraoperative blood loss are the pivotal factors of FFP transfusion.