红细胞输注及其剂量与外科手术部位感染风险的关系

Relationship between red blood cell infusion and its dose and the risk of surgical site infection

目的:研究红细胞输注及其剂量与外科手术部位感染(SSI)风险的关系。方法:回顾性分析2017年1月~2021年12月于我院行外科手术的342例患者的临床资料,根据患者术后是否发生SSI,将其分为SSI组(n=26)与无SSI组(n=316),比较两组患者性别、年龄、手术部位(浅层组织、深层组织、器官手术)、麻醉方式、是否术中输血、手术时机、病史(心血管病史、高血压病史、糖尿病病史)、吸烟史、引流管留置时间、手术时间、收缩压、舒张压、身体质量指数、术前心率、术中出血量、术前体温、红细胞输注剂量、万古霉素局部用药情况。通过ROC分析年龄、引流管留置时间、术中出血量、红细胞输注剂量预测外科手术术后发生SSI的价值,并采用多因素Logistic回归分析明确外科手术术后发生SSI的独立危险因素。结果:两组患者性别、手术部位、麻醉方式、手术时机、手术方式、切口分类、病史、吸烟史、手术时间、收缩压、舒张压、身体质量指数、术前心率、术前体温、万古霉素局部用药例数比较差异无统计学意义;SSI组患者年龄、引流管留置时间、术中出血量、红细胞输注剂量显著高于对照组,术中输血例数占比显著大于对照组;经ROC分析,年龄≥61.7岁、引流管留置时间≥3.636 d、术中出血量≥553.321 mL、红细胞输注剂量≥5.678 U是外科手术术后发生SSI的最佳截断值;Logistic回归分析显示术中输血、年龄≥61.7岁、引流管留置时间≥3.636 d、术中出血量≥553.321 mL、红细胞输注剂量≥5.678 U是外科手术术后发生SSI的独立危险因素。结论:外科手术术后发生SSI与患者术中输血、年龄、引流管留置时间、术中出血量、红细胞输注剂量关系密切,因此应严格把控红细胞输注适应症及输注剂量,结合相关因素采取针对性措施以降低外科手术术后SSI发生率。

Objective To investigate the relationship between red blood cell infusion and its dose with the risk of surgical site infection (SSI).Methods The clinical data of 342 patients who underwent surgery in our hospital from January 2017 to December 2021 were retrospectively analyzed.According to the occurrence of POSTOPERATIVE SSI,the patients were divided into SSI group (n=26) and NON-SSI group (n=316).Compare two groups of patients with gender,age,surgical site (shallow and deep tissue,organ surgery),anesthesia,whether transfused,timing of surgery,and medical history,history of cardiovascular disease,hypertension,diabetes),smoking history,drainage tube indwelling time,operation time,systolic pressure,diastolic blood pressure,body mass index (BMI),preoperative heart rate,intraoperative blood loss,preoperative body temperature,Red blood cell infusion dose and vancomycin local administration.ROC was used to analyze the predictive value of age,drainage tube indplacement time,intraoperative blood loss,and red blood cell infusion dose in predicting SSI after surgery,and multivariate Logistic regression analysis was used to determine the independent risk factors for SSI after surgery.Results There were no significant differences in gender,surgical site,anesthesia method,surgical opportunity,surgical method,incision classification,medical history,smoking history,surgical time,systolic blood pressure,diastolic blood pressure,body mass index,preoperative heart rate,preoperative temperature,and the number of local vancomycin use cases between 2 groups.Age,drainage tube indplacement time,intraoperative blood loss and red blood cell infusion dose in SSI group were significantly higher than those in control group,and the proportion of intraoperative blood transfusion cases was significantly higher than that in control group,with statistical significance.According to ROC analysis,age ≥61.7 years,drainage tube indplacement time ≥3.636 d,intraoperative blood loss ≥553.321 mL,red blood cell infusion dose ≥5.678 U were the best truncation values for POSTOPERATIVE SSI.Logistic regression analysis showed that intraoperative blood transfusion,age ≥61.7 years,drainage tube indplacement time ≥3.636 d,intraoperative blood loss ≥553.321 mL,red blood cell infusion dose ≥5.678 U were independent risk factors for POSTOPERATIVE SSI.Conclusion Postoperative SSI is closely related to intraoperative blood transfusion,age,drainage tube indplacement time,intraoperative blood loss and red blood cell infusion dose.Therefore,indications and infusion dose of red blood cell infusion should be strictly controlled,and targeted measures should be taken in combination with relevant factors to reduce the incidence of postoperative SSI.