Stanford A型主动脉夹层行孙氏手术患者围术期红细胞输注影响因素评估

Risk factors for perioperative red blood cells transfusion in patients with type A aortic dissection undergoing Sun′s operation

目的:分析Stanford A型主动脉夹层行孙氏手术患者围术期红细胞输注的影响因素。方法:回顾性分析2013年1月至2018年5月于兰州大学第一医院行孙氏手术的85例Stanford A型主动脉夹层患者的临床资料。根据此类患者临床围术期输血情况分为常规输血组(输注红细胞≤8 U,n=47)和超量输血组(输注红细胞>8 U,n=38),对2组患者围术期超量红细胞输注相关危险因素行多因素logistics回归分析。结果:Stanford A型主动脉夹层行孙氏手术患者围术期超量红细胞输注的危险因素是体外循环总转机时间(OR=1.022,95%CI:1.010～1.035,P<0.001),保护因素为高血压(OR=2.883,95%CI:1.046～7.944,P=0.041)。超量红细胞输注对此类患者的术后生存率有显著影响(P=0.028)。结论:Stanford A型主动脉夹层行孙氏手术患者的术中体外循环总转机时间越长,其超量红细胞输注风险越高;术前合并高血压的患者围术期超量红细胞输注风险较低。超量红细胞输注能够增加此类患者的术后死亡率。

Objective:To investigate the risk factors related factors for perioperative red blood cells transfusion in patients with type A aortic dissection underwent Sun′s operation. Methods:Clinical data of 85 patients with type A aortic dissection who underwent Sun′s operation in the First Hospital of Lanzhou University from January 2013 to May 2018, were retrospectively analyzed. According to the clinical perioperative blood transfusion status, these patients were divided into routine transfusion group(≤8 RBC units, n=47) and massive transfusion group(>8 RBC units, n=38). Logistics regression analysis was used to explore the risk factors of massive red blood cell transfusion during perioperative period. Results:The time of cardiopulmonary bypass(OR=1.022, 95%CI: 1.010-1.035, P<0.001) was found to be a risk factor for massive red blood cell transfusion in patients with Stanford A aortic dissection undergoing Sun′s operation. The protective factor was hypertension(OR=2.883, 95%CI: 1.046-7.944, P=0.041). Massive red blood cell transfusion was significantly associated with the postoperative survival rate of these patients(P=0.028). Conclusions:For patients with Stanford type A aortic dissection undergoing Sun′s operation, longer time of cardiopulmonary bypass results in higher risk for massive red blood cell transfusion, while patients with hypertension have lower risk. And massive red blood cell transfusion could increase postoperative mortality in these patients.