先天性心脏病患儿术中输血影响因素研究

Study on the influence factors of blood transfusion in children with congenital heart disease

目的了解先天性心脏病患儿术中输血的特点、术中输血的影响因素,筛选适用于临床术前评估患儿输血风险的指标,以期为患儿提供精细化输血治疗。方法回顾性分析2015年1-2月份于北京安贞医院小儿心脏外科行先天性心脏病手术的患儿病历资料300例。按照年龄分组:0-12M组,1-3岁组,3岁以上组。将可疑的影响因素进行组间比较后,将有统计学意义的影响因素进行多因素logistic回归分析,筛选各组患儿输血的影响因素。结果300例患儿中,238例接受术中输血治疗,输血率为79.33%。0-12M组输血率为95.45%;1-3岁组输血率为82.02%;3岁以上输血率为29.82%。logistic分析显示,0-12M组,体术前血红蛋白浓度是该组患儿输血的影响因素;1-3岁组,年龄、术前血红蛋白浓度是该组患儿输血的影响因素;3岁以上组,体重、术中出血量是该组患儿输血的影响因素。结论结合先心病患儿的用血特点及各年龄组输血影响因素,可综合评估患儿术中输血风险,实现患儿术前个性化备血方案。

Objective To understand the intraoperative transfusion characteristics,the risk factors associated with intraoperative blood transfusion,and to screen the markers for evaluating the risk of blood transfusion in preoperative period.Methods Medical records of 300 children who received selected pediatric congenital heart disease surgeries in Anzhen hospital from January to February in 2015 were enrolled and retrospectively analyzed.The children were divided into three groups：0-12 months old group,1-3 years old group,and over 3 years old group.Then,every group was divided into blood transfusion group and non-transfusion group,according to whether or not they had received intraoperative blood transfusion.Univariate analysis and multivariate logistic regression analysis were used to investigate the risk factors for intraoperative blood transfusion.The relationship between the intraoperative blood transfusion of neonate with different degree of anemia and prognosis also was analyzed.Results Of the 300 children in the study,238（79.33%） received transfusion.In 0-12 M group,transfusion rate was 95.45%;in 1-3Y group,the transfusion rate was 82.02%;in over 3Y group,transfusion rate was 29.82%.Multivariate logistic regression analysis indicated that the risk factors of intraoperative blood transfusion in 0-12 M group was preoperative Hb concentration,in 1-3Y group were age and preoperative Hb concentration,in over 3Y group were age and the loss of blood during operation.Conclusion Combined with the characteristics of blood transfusion in children with congenital heart disease and the influential factors of blood transfusion in all age groups,a comprehensive assessment of the risk factors of blood transfusion in children can be integrated to achieve the preoperative preparation of blood for children.