脊柱围手术期异体输血的相关因素

Factors associated with allogeneic transfusion during perioperative period of spinal surgery

[目的]通过分析脊柱手术围手术期输血的影响因素,建立合适有效的输血评估模型,为临床提供合适的建议及证据,优化输血管理,最大限度地节约血资源并减少输血相关风险。[方法]回顾性分析2020年1月-2021年6月在本院接受脊柱手术268例患者的临床资料,根据围手术期是否输血分为输血组和未输血组,记录患者基本人口学特征、基础疾病情况、术前状态评估指标及手术相关资料。采用单项因素比较,二元多因素逻辑回归分析输血的独立影响因素,并应用多元线性回归构建输血量预测模型。[结果]单项因素比较表明,输血组的创伤、肝病、腰椎手术、减压融合术式和未使用抗凝药物的比率显著高于未输血组(P<0.05);输血组的术前ASA评级和切口愈合评级显著差于未输血组(P<0.05);此外,输血组的术前Hb、HCT、Alb浓度均显著低于未输血组(P<0.05);而输血组的手术节段数、手术时间、术中失血量及术后引流量均显著高于未输血组(P<0.05)。但是,两组年龄、性别和BMI,是否合并糖尿病、高血压和肾脏疾病,以及术前PT和术前APTT的差异均无统计学意义(P>0.05)。逻辑回归表明:术中失血量(OR=1.010,P<0.05)、手术时间(OR=1.020,P<0.05)是输血的独立危险因素。而术前HCT(OR=0.844,P<0.05)是输血的保护因素。51例输血者的多元逐步回归表明:手术节段数(Xs)(B=2.118,P<0.001)和术前Alb水平(Xa)(B=-0.439,P=0.017)是影响输血量(Y)的主要因素,回归方程为:Y=16.063+2.118Xs-0.439Xa。[结论]改善术前情况,减少手术创伤是减少脊柱手术输血的途径。手术节段数和术前Alb水平是评估输血量的重要因素。

[Objective]To establish an appropriate and effective blood transfusion evaluation model by analyzing the influencing factors of perioperative blood transfusionin spinal surgery,so as to provide appropriate suggestions and evidence for clinical practice,optimize blood transfusion management,save blood resources to the maximum extent and reduce transfusion-related risks.[Methods]A total of 268 patients who received spinal surgery in our hospital from January 2020 to June 2021 were retrospectively analyzed and divided into transfusion group and non-transfusion group according to perioperative blod transfusion or not.The basic demographic data,comorbidities,preoperative status and operative documents were recorded.The independent impacting factors of blood transfusion were analyzed by univariate comparison and binary multiple logistic regression,while prediction model of blood transfusion volume was constructed by multiple linear regression.[Results]In term of univariate comparison,the transfusion group proved significantly higher than the non-transfusion group in ratio of trauma,liver disease,the lumbar surgically involved,decompression and fusion,and no anticoagulants used(P<0.05).The former was significantly worse than the latter in the preoperative ASA grade and incision healing grade(P<0.05).In addition,the transfusion group had significantly lower preoperative Hb,HCT and Alb,whereas significantly greater number of segments surgically involved,operative time,intraoperative blood loss and postoperative drainage volume than the non-transfusion group(P<0.05).However,there were no statistically significant differences between the two groups in age,sex,BMI,diabetes,hypertension,and kidney disease,and preoperative PT and APTT(P>0.05).As results of logistic regression,the intraoperative blood loss(OR=1.010,P<0.05)and operation time(OR=1.020,P<0.05)were the independent risk factor for blood transfusion,while the preoperative HCT(OR=0.844,P<0.05)was a protective factor for blood transfusion.Regarding multiple stepwise regression of 51 patients who received transfusion,the number of segments surgically involved(Xs)(B=2.118,P=0.001)and preoperative Alb(Xa)(B=-0.439,P=0.017)were the main factors of predicating blood transfusion volume(),with the regression equation as follows:Y=16.063+2.118Xs-0.439Xa.[Conclusion]Improving patients'preoperative condition and reducing surgical trauma is the way to reduce blood transfusion in spinal surgery.The number of segments surgically involved and preoperative Alb are important factors in the evaluation and transfusion volume.