术前贫血对二尖瓣手术患者围术期输血的影响

Impact of preoperative anemia on perioperative blood transfusion and outcomes in patients undergoing mitral valve surgery

目的探讨二尖瓣手术患者术前贫血与围术期输血的相关性以及对术后转归的影响。方法应用输血信息管理系统及SPSS软件回顾性收集并分析2017年本院493名实施初次择期二尖瓣手术患者的临床资料、相关实验室检查结果及输血量和患者转归数据,根据患者是否存在术前贫血(男性Hb<120 g/L、女性Hb<110 g/L),分为贫血组(n=34)和非贫血组(n=459)。针对计量资料做秩和检验,对计数资料做Fisher检验和卡方检验,对以上结果分析并最终做线性回归及Logistic回归统计。结果本组二尖瓣手术患者术前贫血发生率为6.90%(34/493);贫血组与非贫血组围术期红细胞用量(U)(中位数):4.00 vs 0.00(回归系数B 2.55、95%CI 1.70~3.40,P<0.05);红细胞输注率:67.65%vs 21.35%(比值比OR 12.28、95%CI 5.21~31.15,P<0.05);ICU停留时间(d)(中位数):2.50 vs 2.00(回归系数B 0.71、95%CI 0.08~1.33,P<0.05);住院死亡率:5.88%vs 0.22%(P<0.05)。结论术前贫血是二尖瓣手术患者围术期输注红细胞的独立危险因素,延长术后ICU停留时间可能增加住院死亡率。

Objective To explore the relationship between preoperative anemia and perioperative red blood cell(RBC)transfusion and postoperative outcomes in patients undergoing mitral valve surgery.Methods The clinical data,laboratory findings,blood transfused and outcomes data of 493 patients who underwent mitral valve surgery in Fuwai Hospital in 2017 were collected by blood transfusion management system and retrospectively analyzed by SPSS.The patients were divided into anemia group(n=34,male Hb<120 g/L and female Hb<110 g/L)and non-anemia group(n=459).The measurement data were statistically analyzed with t test or rank sum test,and enumeration data by Fisher test and Chi-square test,and then all analyzed by binary logistics regression.Results The incidence of anemia before mitral valve surgery was 6.90%(34/493).Perioperative erythrocyte dosage(U)(median),erythrocyte transfusion rate,ICU stay time(d)(median)and hospital mortality rate(%)in anemia group and non-anemia group were 4.00 vs 0.00(OR:2.55,95%CI:1.70~3.40,P<0.05),67.65%vs 21.35%(OR:12.98,95%Cl:5.21~31.15,P<0.05),2.50 vs 2.00(B:0.71,95%Cl:0.08~1.33,P<0.05)and 5.88 vs 0.22(P<0.05)respectively.Conclusion Preoperative anemic is independently associated with perioperative RBC transfusion in patients undergoing mitral valve surgery,and may increase ICU length of stay and hospital mortality.