肺移植患者围术期红细胞输注量的影响因素分析

Influencing factors of perioperative red blood cell transfusion in patients underwent lung transplantation

目的探讨肺移植患者围术期红细胞输注量的影响因素,为肺移植围术期患者血液管理(PBM)提供数据支持。方法从本院病案管理及数字化系统收集本院肺移植科2017年3月~2019年6月完成的全部173例肺移植手术的临床资料,以患者围手术期红细胞输注量≥6 U(以200 mL全血制备的红细胞计为1 U)与否分为大量输血组(≥6 U,n=66)和非大量输血组(<6 U,n=107),对2组患者基本信息、术前实验室检查结果、手术情况等相关临床资料做回顾性单因素分析比较,将二者比较P<0.15的指标进一步纳入二元Logistic回归分析,找出肺移植患者围术期大量输血的独立影响因素。结果大量输血组与非大量输血组患者的吸烟史比例、体重指数(BMI)相近(P<0.05);术前Hb(g/L) 124(111,138.8)vs 138(126,149),Hct(%) 37.9(34.8,42.5)vs 41.3(37.9,44.6),手术时长(min)327.9±107.7 vs 238.4±77.0,术中失血量(mL)1 108.6±1 342.0 vs 341.8±270.8(P<0.01);单肺移植42.4%(28/66)vs 78.5%(84/107)(P<0.01)。Logistic回归分析:术中失血量(OR=1.001,P<0.05),手术时长(OR=1.006,P<0.05),术前Hb(OR=0.973,P<0.01),肺移植类型(单、双肺移植)(OR=0.247,P<0.05),体外膜肺氧合(ECMO)(OR=0.187,P<0.01)是肺移植患者围术期大量输注红细胞的独立影响因素。结论术中失血量、手术时长是围术期大量输血的危险因素;而术前Hb水平、围术期使用ECMO以及单肺移植(较双肺移植而言)是围术期大量输血的保护因素。

Objective To explore the influencing factors of perioperative red blood cell transfusion in patients underwent lung transplantation, so as to provide reference for perioperative blood management(PBM) of lung transplantation patients. Methods The clinical data of 173 lung transplant patients completed in China-Japan Friendship Hospital from March 2017 to June 2019 were retrospectively analyzed. The patients were divided into two groups according to perioperative red blood cell transfusion volume: large blood transfusion group(transfusion red blood cell volume ≥6 U, n=66) and non-large blood transfusion group(red blood cell transfusion volume <6 U, n=107).The basic information, preoperative laboratory test results, and surgical status of the two groups were statistically analyzed.The clinical data of the two groups were analyzed by univariate analysis. The factors of P<0.15 were included in the binary logistic regression analysis, and the independent influencing factors of perioperative massive blood transfusion in patients with lung transplantation were found. Results Univariate analysis of clinical data of the two groups of patients(large blood transfusion group vs. non-large blood transfusion group) showed that the differences of smoking history ratio[44(66.7%) vs 87(81.3%)], BMI(20.8±4.5 vs 22.5±4.0)(P<0.05), preoperative Hb[124(111,138.8) vs 138(126,149)], preoperative Hct [37.9(34.8,42.5) vs 41.3(37.9,44.6)], surgery duration(327.9±107.7 vs 238.4±77.0), intraoperative blood loss(1 108.6±1342.0 vs 341.8±270.8) and single lung transplantation [28(42.4%) vs 84(78.5%)](P<0.01) were statistically significant. Logistic regression analysis showed that intraoperative blood loss(OR=1.001, P<0.05), surgery duration(OR=1.006, P<0.05), preoperative Hb(OR=0.973, P<0.01), lung transplantation type(single or double lung transplantation)( OR=0.247, P<0.05) and extracorporeal membrane oxygenation(ECMO)(OR=0.187, P<0.01) were independent factors influencing red blood cell transfusion during lung transplantation. Conclusion Intraoperative blood loss and surgery duration are risk factors for massive blood transfusion during the perioperative period. And the use of ECMO, preoperative Hb, single lung transplantation(compared to double lung transplantation) are protective factors for perioperative massive blood transfusion.