大量输血患者用血情况及临床预后的回顾性分析

Blood consumption and clinical prognosis in patients with massive blood transfusion:a retrospective analysis

目的了解医院临床大量输血的发生率、大量输血患者的科室占比以及血液成分输注现状等,进一步为医疗决策和大量输血的研究提供基础理论依据。方法收集本院2014年1月1日~2018年12月31日489例(514次)大量输血患者的基本临床资料以及血液成分输注情况,本研究为回顾性队列研究。结果本院5年期间大量输血的发生率为1.2/1000住院人次(95%CI:1.1~1.3),30 d全因死亡率为21.88%;发生大量输血的科室中,创伤急诊科的死亡率最高(60%),其次为重症医学科(ICU)(56.25%)以及其他外科(46.67%),而产科大量输血患者无死亡;所有的大量输血患者均输注了红细胞:中位数为14(11.5~19.13)U;血浆,中位数为1600(1200~2200)mL;47%的患者输注了血小板,中位数为0(0~10)U;32.68%的患者输注了冷沉淀,中位数为0(0~10)U;全因死亡风险logistics回归分析结果显示:与青年组相比较,老年患者(65岁<年龄≤79岁):OR=2.471,95%CI=[1.044,5.847],P<0.05;老年患者(年龄>80岁):OR=7.563,95%CI=[1.587,36.049],P<0.05。24 h红细胞输注量>18 U的患者(18≤RBC<27:OR=2.94895%CI=[1.592,5.462],P<0.05;RBC≥28:OR=3.992,95%CI=[1.178,13.536],P<0.05)30 d全因死亡风险较高。结论大量输血研究应该纳入动态定义,如果我们仅使用24 h RBC输注量≥18 U作为大量输血定义,将丢失约68%的案例;大量输血患者死亡率较高,其中心脏外科、普外科以及骨外科是大量输血发生率较高的科室;女性患者大量输血人次持续增加,应该给与更多关注;此外65岁以上的老年患者以及24 h红细胞输注量≥18 U患者的30 d全因死亡风险最高。

Objective To investigate the incidence of clinical massive blood transfusion in hospitals,the proportion of departments conducted massive blood transfusion and the current situation of component transfusion,so as to provide a theoretical basis for medical decision-making and further research on massive blood transfusion.Methods The basic clinical data and transfusion of blood components were retrospectively collected from 489 patients(514 occasions)who received massive blood transfusion at Sun Yat-sen Memorial Hospital of Sun Yat-sen University from Jan.12014 to Dec.312018.Results The incidence of massive blood transfusion during the 5-year period was 1.2/1000 inpatients(95%CI:1.1-1.3),and the 30-day all-cause mortality was 21.88%;in the departments where massive blood transfusion occurred,the mortality rate was the highest in the trauma emergency department(60%),followed by intensive care unit(56.25%)and other surgery department(46.67%),while there was no death in the obstetric department.All patients received red blood cells[median 14 U(11.5-19.13)]and plasma[median 1600 mL(1200-2200)],of which 47%received platelet[median 0 U(0-10)]and 32.68%received cryoprecipitate[0 U(0-10)].The results of logistics regression analysis of all-cause mortality risk showed that compared with the youth group,the risk of all-cause death at 30 days of elderly patients over 65 years old(65<age≤79 years old:OR=2.471,95%CI=[1.044,5.847],P<0.05;patients with age>80 years old:OR=7.563,95%CI=[1.587,36.049],P<0.05)and 24-hour RBC infusion volume greater than 18 U(18≤RBC<27:OR=2.94895%CI=[1.592,5.462],P<0.05;RBC≥28:OR=3.992,95%CI=[1.178,13.536],P<0.05)was higher.Conclusion A dynamic definition should be included in massive transfusion studies.If only a 24-hour RBC infusion volume≥18 U was used as the mass transfusion definition,about 68%of cases would be lost.The mortality rate of patients with massive blood transfusion was higher,and the incidence of massive blood transfusion was higher in the departments of cardiac surgery,general surgery and orthopedics surgery.More attention should be paid to the increasing number of female patients with massive blood transfusion.In addition,the risk of 30-day all-cause death was highest in elderly patients over 65 years of age and those with a 24-hour erythrocyte transfusion level of≥18 U.