肝细胞癌右半肝切除术围术期异体红细胞输注情况分析

Analysis of related factors of allogeneic erythrocyte transfusion during right hepatectomy for hepatocellular carcinoma

目的探讨有关肝细胞癌(HCC)患者右半肝切除术围术期输血安全的影响因素。方法收集2016—2019年本院肝脏外科肝细胞癌住院患者接受右半肝切除术的215名患者病历信息,根据围术期是否输注输异体红细胞分为输异体红细胞组(n=58)和未输异体红细胞组(n=157),回顾性分析比较2组患者的临床基本资料、实验室检查结果、手术相关信息以及患者术后转归情况,筛选出此类患者围术期异体红细胞输注的相关影响因素。结果本组肝细胞癌右半肝切除术患者的围术期输注异体红细胞比例为26.98%(58/215);输注与未输注异体红细胞患者比较:术前血红蛋白(Hb)(g/L)为124.72±24.50 vs 131.35±19.08(P<0.01),术前凝血酶原时间(PT)(s)为12.55 (11.80,14.03)vs 12.60 (11.80,13.55):术前AFP(μg/L)≥400者为29.3%(17/58)vs 23.6%(37/157)、<400者为70.7%(41/58)vs 76.4%(120/157)(P<0.01),手术时间(h)为5.71±1.16 vs 5.07±1.22(P<0.01),术中出血量(mL)600.00(437.50,1050.00)vs 300.00 (200.00,550.00)(P<0.01),住院时间(d)为23.50(19.00,29.00)vs 20.00(16.00,24.00))(P<0.01)。结论通过术前Hb、PT、AFP检测及术中出血量、手术时间可预估HCC右半肝切除术患者围术期是否需要输注异体红细胞及其输注量;患者住院时间可体现输注异体红细胞对患者转归的影响。

Objective To explore the factors influencing the safety of perioperative blood transfusion during right hepatectomy in patients with hepatocellular carcinoma, and to provide data basis for strengthening blood safety during perioperative period and establishing accurate blood transfusion model for such patients. Methods The medical records of 215 patients who underwent right hepatectomy for hepatocellular carcinoma and were hospitalized in our hospital from 2016 to 2019 were collected. According to whether they received allogeneic blood transfusion during perioperative period or not, the patients were divided into allogeneic erythrocyte transfusion group(n=58) and non-allogeneic transfusion group(n=157). The demographic information, laboratory test results, surgery-related information and postoperative outcomes of patients were studied for the relevant influencing factors of perioperative allogeneic blood transfusion in such patients. Results 58 patients(26.98%, 58/215) received allogeneic erythrocyte transfusion during perioperative period. Such parameters were significantly comparable between allogeneic and non-allogeneic erythrocyte transfusion group:AFP, preoperative Hb concentration(g/L)(124.72±24.50 vs 131.35±19.08), preoperative prothrombin time(PT)(s)[12.55(11.80,14.03) vs 12.60(11.80,13.55)], operation time(h)(5.71±1.16 vs 5.07±1.22) and intraoperative blood loss(mL)[600.00(437.50,1050.00) vs 300.00(200.00,550.00)](P<0.05).The influencing factor for allogeneic blood transfusion was the length of hospital stay(d): 23.50(19.00, 29.00) in allogeneic erythrocyte transfusion group vs 20.00(16.00, 24.00) in non-allogeneic transfusion group(P<0.05). Conclusion Preoperative Hb, PT,AFP, intraoperative blood loss and operation time can be used to making decision in allogeneic blood transfusion practice and transfusion volume for patients with hepatocellular carcinoma requiring right hemihepatectomy during perioperative period.The length of hospital stay reflects the impact of allogeneic blood transfusion on patients′ outcome.