新型术前最大备血量的建立在行游离皮瓣重建术的颌面部恶性肿瘤患者的研究

Establishment of Preoperative Maximum Blood Order Schedule for Maxillofacial Malignant Tumor Patients Undergoing Free Flap Reconstruction

【目的】建立行游离皮瓣重建术的颌面部恶性肿瘤手术的最大备血量目录(MSBOS),以指导临床医生合理用血以及输血科科学备血。【方法】收集本院颌面外科2010年1月1日~2020年12月31日围手术期患者的基本资料和输血数据,包括年龄、性别、体质量指数(BMI)、术前血红蛋白值、美国麻醉医师协会(ASA)分级、恶性肿瘤TNM分期系统中T分期、游离皮瓣是否含有骨瓣,手术方式(6类)、申请备血量以及术中用血量等,共纳入颌面外科择期手术1953例,并通过单因素和多因素Logistic回归分析,筛选出患者围术期输血的独立危险因素,并根据危险因素建立评分标准;根据手术方式将患者分为6大组,通过评分标准进一步将每组患者分为低危、中危和高危组,计算各小组患者术中实际输血量频率的累计百分比,建立颌面外科患者的MSBOS。【结果】①经回归分析发现BMI、肿瘤T分期、ASA分级、术前血红蛋白(男性Hb<130 g/L,女性<120 g/L)、游离皮瓣含骨瓣为围术期输血的独立危险因素。②根据危险因素评分分组后发现各组患者中低危组的输血率最低,但备血输血比最高。③建立本院行游离皮瓣重建术的颌面部恶性肿瘤患者的MSBOS,分析发现建立MSBOS后患者手术前备血总量比建立前理论上可以减少54.35%。【结论】建立MSBOS不但有益于更科学、合理地指导手术备血,保障手术安全,而且可以优化血液库存管理,尤其对于低危组的患者应当采取保守的备血方案,有效减少过度备血的状况,节约血液资源。

【Objective】To establish the maximum blood order schedule(MSBOS)for maxillofacial malignant tumor surgery of patients undergoing free flap reconstruction so as to guide clinicians in using blood rationally and prepare blood scientifically by the department of blood transfusion.【Methods】Basic information and blood transfusion data of patients in the perioperative period of maxillofacial surgery in our hospital from January 1,2010 to December 31,2020 were collect⁃ed,including age,gender,body mass index(BMI),preoperative hemoglobin value,ASA staging,T staging,and wheth⁃er the free flap contains bone flaps,surgical methods(category 6),the amount of blood ordered for preparation,and the amount of blood used in the operation.A total of 1953 cases of elective surgery in maxillofacial surgery were included.The univariate and multivariate logistic regression analyses of perioperative transfusion were performed to screen out indepen⁃dent risk factors for perioperative transfusion and establish scoring criteria.According to the surgical method,the patients were divided into 6 groups,then each group of patients was further divided into low-risk,intermediate-risk and high-risk groups in accordance with scoring standard.The cumulative percentage of the actual intraoperative blood transfusion fre⁃quency of each group of patients was calculated to establish the MSBOS of the maxillofacial surgery patients.【Results】①Regression analysis found that BMI,tumor T staging,ASA grade,preoperative hemoglobin(Male Hb<130 g/L,female Hb<120 g/L),and free flaps containing bone flaps were independent risk factors for perioperative blood transfusion.②According to risk factor scores,it was found that the low-risk group had the lowest blood transfusion rate,but cross match to transfusion ratio was the highest.③The MSBOS of maxillofacial malignant tumor patients who underwent free flap recon⁃struction in our hospital was established.The analysis found that after MSBOS was established,the total amount of blood prepared before the operation could theoretically be reduced by 54.35%than before the establishment.【Conclusion】The establishment of MSBOS is not only beneficial for guiding the blood preparation more scientifically and reasonably,but al⁃so can optimize the management of blood inventory and save blood resources.