冠状动脉旁路移植术患者术前贫血与围术期并发症的相关性研究

Correlation between preoperative anemia and perioperative complications in CABG patients

目的通过回顾性分析,研究冠状动脉旁路移植(CABG)患者术前贫血与术后输血量及其他并发症之间的相关性.方法回顾性对比研究我院2018年1~6月择期行CABG的患者,排除术前3个月内有出血、术前血小板计数<100×109/L、血液病、术后因外科因素导致的二次开胸手术患者;按照贫血诊断标准,将符合人选标准的患者分为正常组和贫血组,贫血组再分为轻度贫血组和中度贫血组.收集患者术前的基础资料以及术后的输血量、输血率、肝功能损害、肾功能损害、住ICU时间、住院时间及住院死亡率.结果最终符合人选标准的患者共计389例,其中正常组306例(78.67%),贫血组83例(21.34%),轻度贫血77例(19.80%),中度贫血6例(1.54%);正常组和贫血组术前基线资料上除血红蛋白含量存在显著差异外,年龄、糖尿病、慢性肾脏病(CKD)、既往心脏手术例数贫血组高于正常组,体重指数(BMI)和术前血小板计数贫血组低于正常组,差异均有统计学意义(P<0.05);术后住院死亡率两组无差异,贫血组急性肝肾功能损害、红细胞、血浆、血小板补充量、输血率、住ICU时间及住院时间均高于正常组,差异有统计学意义(P<0.05);轻度和中度贫血组基线资料除血红蛋白含量外其他均无差异性,术后中度贫血组除红细胞补充量多于轻度贫血组外,其他均无显著性差异.结论高龄、合并糖尿病、CKD、营养不良和既往曾行心脏外科手术是冠心病术前贫血患者的高危因素,术前贫血增加CABG患者术后的输血量,并导致术后肝肾功能损害和延长住ICU时间及住院时间;围术期严格把握输血指征,及时的成分输血纠正贫血,中度贫血患者行CABG手术是安全的.

Objective To investigate the association between preoperative anemia and postoperative blood transfusions and other complications in patients with coronary artery bypass grafting ( CABG). Methods Patients with CABG from January 2018 to June 2018 were enrolled. According to the diagnostic criteria for anemia, patients were divided into normal group, mild anemia group and moderate anemia group. The preoperative data and postoperative blood transfusion, transfusion rate, liver function damage, renal dysfunction, time o f ICU stay, length o f hospital stay and hospital mortality were collected. The measured data were analyzed by multivariate logistic regression analysis. Results There were significant differences in hemoglobin content between the normal group and the anemia group. The age, diabetes, chronic kidney disease ( C K D ) and previous cardiac surgery in anemia group were higher than normal group;body mass index (BM I) and preoperative platelet count anemia group were significantly lower than the normal group (P<0.05);there was no difference in postoperative hospital mortality between the two groups. Acute liver and kidney dysfunction, the amount of erythrocyte, plasma and platelet supplementation. Blood transfusion rate, ICU stay and hospital stay in the anemia group were higher than the normal group, with statistical differences( P <0.05);baseline data between the mild and moderate anemia group were not different except hemoglobin. There were no significant differences except more red blood cell supplements than in the mild anemia group. Conclusion Old age, diabetes mellitus, C K D , malnutrition and previous cardiac surgery are risk factors for preoperative anemia in patients with coronary heart disease. Preoperative anemia increases postoperative blood transfusion in CABG patients and leads to postoperative liver and kidney dysfunction and prolonged ICU time and hospitalization time. With perioperative strict control o f blood transfusion indications and timely component transfusion to correct anemia, moderate anemia patients undergoing CABG surgery is safe.