基于倾向性评分匹配的急性等容血液稀释对胃肠手术患者术后谵妄的影响

Effect of acute normovolemic hemodilution on the delirium of postoperative in patients with gastrointestinal surgery based on the propensity score matching

目的应用倾向性评分匹配探讨急性等容血液稀释(acute normovolemichemodilution,ANH)对胃肠手术患者术后谵妄的影响。方法回顾分析2017年1—12月在南通大学附属医院普外科进行的消化道肿瘤手术484例的患者资料,包括患者的一般资料、围术期资料以及实验室检查结果等,根据是否应用ANH将患者分为ANH组(n=158)和对照组(n=326),应用倾向性评分匹配分析两组患者苏醒延迟、谵妄以及二次插管的发生率。结果在倾向性评分匹配前,ANH组性别、体重、血容量、抽烟和酗酒比例明显高于对照组(P<0.05)。通过倾向性评分匹配,152例对照组患者与152例ANH组患者配对成功,以上指标两组差异无统计学意义。ANH组有13例(8.5%)输注红细胞悬液,明显低于对照组的22例(14.4%)(P<0.05);对照组谵妄发生率17例(11.3%),明显高于ANH组的10例(6.8%)(P<0.05)。结论胃肠手术患者围术期应用急性等容血液稀释技术,异体输血量少,苏醒期谵妄发生率低。

Objective To evaluated the effect of acute normovolemic hemodilution（ANH）on postoperative delirium in patients with gastrointestinal surgery using propensity score matching.Methods Perioperative dates and laboratory results were collected from January 2017 to December2017.Patients were divided into ANH group （n = 158）and control group （n = 326）according to the fact using the acute normovolemic hemodilution technique or not.The incidence of delayed recovery,delirium and a second intubation in the two groups of patients were analyzed using propensity score matching method to assess the effect of ANH on the quality of recovery.Results A total of 484 patients were in accordance with the inclusion criteria,326 cases in the control group and 158 in the ANH group.Before the propensity score matching,there were significant differences in the differences of the basic data of the two groups （such as sex,weight,blood volume,etc.）.By using propensity score matching method,152 patients in the control group and 152 cases of the ANH group were matched successfully,and there was no significant difference between the two groups.By using the propensity score matching,cohort analysis showed that 13 cases in the ANH group were infused red cell suspension （8.5%）,22 cases in the control group were transfused red blood cell suspension （14.4%）,there was a significant difference between the two groups （P =0.01）;delirium occurred in 17 cases in the control group （11.3%）,10 cases in the ANH group （6.8%）,there was a significant difference between the two groups （P〈0.05）.Conclusion In the perioperative period ANH can reduce the amount of allogeneic blood transfusion in patients with gastrointestinal surgery and reduce the incidence of postoperative delirium in the waking period.