瓣膜置换手术的非贫血患者术中异体血输注的影响因素分析

Analysis of influencing factors of intraoperative allogeneic blood transfusion in non-anamic patients undergoing valve replacement surgery

目的:心脏手术术中输血是导致围术期不良预后的重要因素之一,分析133例行瓣膜置换的非贫血患者术中输血的影响因素,为心脏瓣膜手术围术期合理输血提供理论依据。方法:纳入2015年1月—2017年12月于我院行瓣膜置换手术的133例患者,按术中是否输注异体血分为异体输血组(51例)和非异体输血组(82例),比较两组患者的临床基本资料、手术相关指标及术前实验室检查结果;采用单因素和多因素Logistic回归分析筛选术中输血的影响因素。结果:本研究共51例患者(38.3%)术中输血,经过多因素Logistic回归分析,显示铁缺乏(OR=2.61,95%CI:1.17~5.82,P<0.05)及年龄(OR=1.05,95%CI:1.02~1.09,P<0.01)是影响术中输注异体血的独立危险因素。结论:年老及铁缺乏的非贫血患者是心脏瓣膜手术术中出血的高发人群,术前可积极补充铁剂纠正铁缺乏状态,减少术中异体血输注。

Objective:Intraoperative blood transfusion is one of the critical factors leading to poor prognosis in cardiac surgery.This study proposes a rational for allogeneic blood transfusion during heart valve replacement surgery by analyzing intraoperative blood transfusion in 133 non-anemic patients.Methods:133 patients who underwent valve replacement surgery in our department from January 2015 to December 2017 were included retrospectively.According to whether they received allogeneic blood transfusion during surgery,patients were divided into transfusion group(n=51)and non-transfusion group(n=82).The clinical data,related surgical indicators,and blood transfusion-related laboratory test results were compared and analyzed.We performed univariate and multivariate logistic regression analysis to explore the influencing factors of intraoperative blood transfusion.Results:A total of 51 patients(38.3%)received intraoperative allogeneic blood transfusion in this study.Multivariate logistic regression analysis revealed that iron deficiency(OR=2.61,95%CI:1.17~5.82,P<0.05)and age(OR=1.05,95%CI:1.02~1.09,P<0.01)were independent risk factors influencing intraoperative blood transfusion.Conclusion:The elderly and sideropenic patients among non-anemic population have a high incidence of bleeding during cardiac valve surgery.A preoperative iron supplement can be used to cure the iron deficiency to reduce intraoperative allogeneic blood infusion.