肝包虫患者行肝切除术围手术期输血的回顾性分析

Perioperative blood transfusion in hepatic hydatid patients undergoing hepatectomy

目的分析肝包虫患者行肝切除术的输血特点和影响因素,为此类患者围术期血液保障提供依据。方法回顾性分析2011年6月至2021年6月行肝切除术的肝包虫患者病例40例,分为输血组(15例)和未输血组(25例),比较2组患者的基本情况、手术相关信息、血常规、凝血功能、生化指标、血栓弹力图的差异,分析围手术期输血特点。结果肝包虫患者行肝切除术的输血率37.5%(15/40),术前输血2例(占5%,5/40),术中输血10例(占25%,10/40),术后输血(术后24 h)11例(占27.5%,11/40),输血患者人均输注4.77U红细胞悬液、1 355 mL血浆、11.9 U冷沉淀,均未发生输血不良反应。输血组的手术时间、术中失血量、切除包块直径≥10 cm/直径<10 cm的患者数、切除胆囊的患者数、术后PT、术后APTT和平均住院日>未输血组(P<0.05),术后FIB小于未输血组(P<0.05)。肝包虫患者行肝切除术后24 h与术前相比,WBC、AST、ALT、INR明显升高(P<0.05),RBC、HB、ALP、FIB、Angle明显降低(P<0.05);术后3~5d的WBC、RBC、Hb、PLT、ALT、ALP、INR与术前相比差异有统计学意义(P<0.05);术后3~5 d的WBC、AST、ALT、FIB与术后24h相比差异有统计学意义(P<0.05)。结论肝包虫患者围术期输血的主要影响因素为包块大小、是否切除胆囊及术中出血量、手术时间、术后PT、术后APTT、术后FIB,主要输注血液成分为血浆和冷沉淀。

Objective To analyze the characteristics and influencing factors of blood transfusion in patients undergoing hepatectomy with hydatid hepatica, so as to provide perioperative blood security of these patients. Methods A retrospective analysis was performed on 40 hydatid hepatica patients who underwent hepatectomy from June 2011 to June 2021, and they were divided into the transfusion group(n=15) and the non-transfusion group(n=25). The difference in basic information, operative information, blood routine, coagulation function, biochemical parameters and thromboelastogram between the two groups were compared, and the characteristics of perioperative blood transfusion were analyzed. Results Fifteen(37.5%, 15/40) patients undergoing hepatectomy received blood transfusion, among which 2(5%,5/40), 10(25%,10/40) and 11(27.5%,11/40) received preoperative, intraoperative and postoperative transfusion, respectively. The average transfusion of suspended red blood cells, plasma and cryoprecipitate were 4.77 U, 1 355 mL and 11.9 U respectively, without any adverse reactions of blood transfusion occurred. The operative time, intraoperative blood loss, the number of patients with tumor diameter ≥10 cm/diameter <10 cm, the number of patients with cholecystectomy, postoperative PT, postoperative APTT and average hospital stay in the transfusion group were higher than those in the non-transfusion group(P<0.05), and the postoperative FIB was lower than those in the non-transfusion group(P<0.05).The blood test results showed that the WBC, AST, ALT and INR 24 h after operation were significantly higher than those before operation(P<0.05), while RBC, Hb, ALP, FIB and Angle were significantly lower than those before operation(P<0.05). There were statistically significant differences in WBC, RBC, Hb, ALT, ALP and INR between preoperative and postoperative 3~5 days(P<0.05). The differences of WBC, AST, ALT and FIB 3~5 days after surgery were statistically significant compared with 24 hours after surgery(P<0.05). Conclusion The size of hepatic hydatid mass, cholecystectomy, intraoperative blood loss, operative time, postoperative PT, postoperative APTT and postoperative FIB were important factors affecting perioperative blood transfusion after hepatectomy, and the main transfusion components were plasma and cryoprecipitate.