骨科择期手术备血策略的建立及术中用血分析

Establishment of Orthopedic Blood Ordering Schedule and Analysis of Perioperative Blood Transfusion

目的探讨骨科择期手术备血策略(SBOS)制定及术中用血量影响因素。方法回顾性分析我院2018年1月~2019年12月骨科择期手术患者2930例,采集红细胞申请量和实际使用量,按手术类型统计患者的输血率、人均红细胞用量、有无大出血风险等指标,制定我院骨科择期手术SBOS;对围术期输血患者的用血信息采用卡方和Logistic回归统计方法进行分析,筛选出影响手术用血量的因素。结果(1)骨科择期手术患者2930例,临床申请用血量5256 U,手术共分15类;其中围术期输血患者142例,共输注红细胞538 U,总输血率4.85%(142/2930),手术输血患者红细胞输注量(3.93±2.63)U。建立我院骨科择期手术SBOS,根据手术备血情况,将手术分为不需要做血型鉴定/抗体筛查、仅需要做血型鉴定/抗体筛查、需要做血型鉴定/抗体筛查及备血3类。(2)多因素Logistic回归分析显示患者的年龄、术前血红蛋白水平、多发伤对围术期红细胞输注量有影响(OR=0.145、3.058、5.683,P均<0.05)。结论建立骨科择期手术SBOS为更好地指导临床备血提供了依据,同时应充分考虑患者的术前血红蛋白水平、是否多发伤、年龄等因素,合理备血和输血。

Objective To establish the surgical blood order schedule(SBOS)and explore the influencing factors of blood transfusion for orthopedic surgery patients.Methods We retrospectively enrolled 2930 patients undergoing elective orthopaedic surgery in our hospital from January 2018 to December 2019,collected the application and actual usage of red blood cells(RBCs),and analyzed the patients’blood transfusion rate,per capita RBCs transfusion,and whether there is a risk of major bleeding according to the type of surgery,to formulate SBOS for elective orthopaedic surgery.We used chi-square and Logistic regression methods to analyze the transfusion information and screened out the factors affecting perioperative transfusion.Results(1)The amount of RBCs application was 5256 U by 2930 patients of 15 surgical categories.The amount of RBCs transfusion was 538 U by 142 cases,with transfusion rate 4.85%and the per capita transfused RBCs amount was(3.93±2.63)U.The SBOS was divide into 3 categories:free Typing/Antibody-Screening(T/A-S),only T/A-S and T/A-S with Crossmatch.(2)Multivariate Logistic regression analysis showed that the patient’s age,preoperative hemoglobin level,and multiple injuries had an effect on perioperative RBCs transfusion(OR=0.145,3.058,5.683,all P<0.05).Conclusion The establishment of SBOS in orthopedic surgery provides a basis for better guidance of clinical blood transfusion.At the same time,the preoperative hemoglobin level,multiple injuries and age should be fully considered.