颅底脊索瘤切除术患者术中出血的影响因素分析

Analysis of influencing factors of intraoperative bleeding in patients with skull base chordoma resection

目的探讨颅底脊索瘤切除术患者术中出血的影响因素,为患者血液管理提供科学依据。方法选择2018年1月至2021年7月首都医科大学附属北京天坛医院行颅底脊索瘤切除术的患者,按术中出血量分为<15%自身血容量组(A组)和≥15%自身血容量组(B组),收集患者的基本资料,分析术中出血及其影响因素。结果共纳入122例患者,其中A组91例,B组31例。122例患者中,男71例、女51例,平均年龄(47.0±11.9)岁。两组患者总失血量400.0(200.0,725.0)ml,术中输血29例(23.8%);肿瘤直径40.1(30.0,50.0)mm,血供丰富的瘤体52例(42.6%),瘤体周围血管受累74例(60.7%)。多因素logistic回归显示,瘤体周围血管受累越严重(OR=8.393,95%CI:1.381~51.013,P=0.021)、术中胶体液的输注量越多(OR=1.003,95%CI:1.001~1.005,P=0.016)和术后PLT值越低(OR=0.984,95%CI:0.972~0.997,P=0.013)的患者,其术中出血风险越高。结论瘤体周围血管受累、术中胶体液的输注量多和患者PLT低是颅底脊索瘤切除术患者术中出血的危险因素。应根据患者血液管理理念及早行干预措施,以减少患者围术期出血量,改善临床预后。

Objective To explore the influencing factors of intraoperative bleeding in patients undergoing skull base chordoma resection and provide scientific basis for blood management of patients.Methods Patients who underwent skull base chordoma resection in Beijing Tiantan Hospital,Capital Medical University from January 2018 to July 2021 were selected,and were divided into<15%self-blood volume group(Group A)and≥15%self-blood volume group(Group B)according to the amount of intraoperative bleeding.The basic information,intraoperative bleeding and its influencing factors of the patients were analyzed.Results A total of 122 patients were included in the study,of which 91 in group A and 31 in group B.There were 71 male and 51 female patients,median age was(47.0±11.9)years old.The total blood loss in two groups was 400.0(200.0,725.0)ml,intraoperative blood transfusion occurred in 29 cases(23.8%),the diameter of the tumor was 40.1(30.0,50.0)mm,52 cases(42.6%)had abundant blood supply,and 74 cases(60.7%)had vascular involvement around the tumor.Multivariate logistic regression showed that the more serious involvement of the blood vessels around the tumor(OR=8.393,95%CI:1.381-51.013,P=0.021),the more colloid fluid was infused during the operation(OR=1.003,95%CI:1.001-1.005,P=0.016)and the lower the postoperative PLT(OR=0.984,95%CI:0.972-0.997,P=0.013),the higher the risk of intraoperative bleeding.Conclusions Peritumoral vascular involvement,large amount of colloid fluid infusion,and low PLT are risk factors for intraoperative bleeding in patients undergoing skull base chordoma resection.Early interventions should be taken as soon as possible according to the patient’s blood management,so as to reduce perioperative blood loss and improve clinical prognosis.